Individual
LAYNE ANDREW ROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2601 E ROOSEVELT ST, PHOENIX, AZ 85008-4973
(602) 344-5011
Mailing address
2929 E THOMAS RD, PHOENIX, AZ 85016-8034
(602) 470-5000
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
009098
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036122908
—
IL
01
—
04515143
BCBS#
IL
Enumeration date
04/10/2009
Last updated
08/05/2021
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