MEDICARE: PETER MARTIN RUSSO MD

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
1	207P00000X	Emergency Medicine Physician	G39732	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00143859	OTHER		RAILROAD MEDICARE RRM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679528350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER MARTIN RUSSO MD

Provider Business Mailing Address
First Line	:	PO BOX 5040
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966
Country	:	US
Telephone Number	:	530-532-8584
Fax Number	:	530-532-8433

Provider Business Practice Location Address
First Line	:	1611 FEATHER RIVER BLVD
Second Line	:	SUITE #10
City	:	OROVILLE
State	:	CA
Zip	:	95965
Country	:	US
Telephone Number	:	530-534-4530
Fax Number	:	530-532-8290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/08/2007

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Directions to “ PETER MARTIN RUSSO MD” Practice Location

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