Individual
RUSSELL H VANNORMAN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1801 FAIRFIELD AVE STE 207, SHREVEPORT, LA 71101-4460
(318) 703-5655
(318) 606-5470
Mailing address
1801 FAIRFIELD AVE STE 207, SHREVEPORT, LA 71101-4460
(318) 703-5655
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
204870
LA
207WX0120X
Cornea and External Diseases Specialist Physician
Primary
204870
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4J088B236
MEDICARE
LA
Enumeration date
05/31/2005
Last updated
04/06/2018
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