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Organization

THOMAS G ROUSSEAU MD PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LINDA DERR (PROVIDER ENROLLMENT SPECIALIST)
(270) 744-9600
Entity
Organization

Contact information

Practice address
110 COUNTRY CLUB DR, MARION, KY 42064-1873
(270) 744-9600
(270) 744-0834
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-0834

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21441
KY

Other

Enumeration date
06/09/2008
Last updated
06/13/2008
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