Individual
LOUIS RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
580 W 8TH ST, UFJP NEUROLOGY, JACKSONVILLE, FL 32209-6533
(904) 244-3960
(905) 244-6562
Mailing address
PO BOX 44008, UFJP NEUROLOGY DEPT., JACKSONVILLE, FL 32231-4008
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
225619-1
NY
2084N0400X
Neurology Physician
Primary
ME20397
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16915
BCBS
FL
Enumeration date
05/11/2006
Last updated
10/14/2009
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