Organization
WESTSIDE DERMATOLOGY ASSOCIATES A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GORDON J RUSSO M.D. (PHYSICIAN)
(504) 391-7525
Entity
Organization
Contact information
Practice address
120 MEADOWCREST ST, SUITE 160, GRETNA, LA 70056-5255
(504) 391-7525
(504) 391-7624
Mailing address
120 MEADOWCREST ST, SUITE 160, GRETNA, LA 70056-5255
(504) 391-7525
(504) 391-7624
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
015208
LA
Other
Enumeration date
12/12/2006
Last updated
03/04/2010
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