Individual
ETHAN BUDD RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
20402 81ST AVENUE SW, VASHON, WA 98070-6253
(206) 304-4344
Mailing address
20402 81ST AVENUE SW, VASHON, WA 98070-6253
(206) 304-4344
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
00018304
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00018304
WASHINGTON STATE MEDICAL LICENSE
WA
Enumeration date
10/12/2019
Last updated
10/12/2019
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