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NPI Code Detail

MEDICARE: RUSSELL J SALOOM PROF MED CORP

MEDICARE: RUSSELL J SALOOM PROF MED CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician018298LA

General Provider Information

NPI Number : 1538169149
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSSELL J SALOOM PROF MED CORP
Provider Business Mailing Address
First Line : PO BOX 82930
Second Line :
City : BATON ROUGE
State : LA
Zip : 70884-2930
Country : US
Telephone Number : 225-766-1110
Fax Number : 225-766-1112
Provider Business Practice Location Address
First Line : 9237 BLUEBONNET BLVD
Second Line :
City : BATON ROUGE
State : LA
Zip : 70810-2808
Country : US
Telephone Number : 225-766-1110
Fax Number : 225-766-1112
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : RUSSELL JAMES SALOOM
Credential : MD
Telephone Number : 225-766-1110
Provider Enumeration Date : 07/26/2005
Last Update Date : 12/19/2007

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Directions to “RUSSELL J SALOOM PROF MED CORP ” Practice Location

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