Individual
JEFFREY ROBERT RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
212 NE NORTON LN, MCMINNVILLE, OR 97128-8470
(503) 435-0130
(503) 435-0145
Mailing address
235 SE NORTON LN, STE B, MCMINNVILLE, OR 97128-8479
(503) 435-0130
(503) 435-0145
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
DP00326
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
231897
—
OR
Enumeration date
06/28/2007
Last updated
12/09/2016
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