Individual
PETER RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
120 OCHSNER BLVD, GRETNA, LA 70056-5255
(504) 391-7620
Mailing address
1000 GIROD ST APT 216, NEW ORLEANS, LA 70113-1991
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/03/2020
Last updated
01/03/2020
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