NPI 1083612469

Gordon J Russo, MD

Practitioner Procedural Dermatology Physician Gretna, LA

Practice location

Address: 120 Meadowcrest St Suite 160, Gretna, LA 70056-5255
Phone: (504) 391-7620
Fax: (504) 391-7524
Mailing address: 3725 Lake Michael CT, Gretna, LA 70056-8326

Registered specialties

Procedural Dermatology Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207NS0135X Licence 015208 (LA)

Other Dermatology providers in Louisiana →

Registry record

NPI: 1083612469
Entity type: Individual
Sex (as registered): Male
NPI issued: 11 Jul 2005
Record last updated: 3 Feb 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.