Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 46091 | MN |
Y | 2081P2900X | Pain Medicine | DO26464 | OR |
NPI | 1184604183 |
---|---|
Provider Name | David P Russo |
First Address | Hood River, OR 97031-1565 |
Second Address | Hood River, OR 97031-1565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 26/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H91329 | (02) |