Individual
PAUL GERARD LARUSSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
233 WINTON M BLOUNT LOOP, MONTGOMERY, AL 36117-3507
(334) 239-2622
(334) 625-7602
Mailing address
233 WINTON M BLOUNT LOOP, MONTGOMERY, AL 36117-3507
(334) 239-2622
(334) 625-7602
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
00014164
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510-95129
BLUE CROSS PROVIDER #
AL
Enumeration date
10/10/2006
Last updated
10/11/2016
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