MEDICARE: FRANK M. RUSSO M.D.

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	207L00000X	Anesthesiology Physician	ME78954	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	58400	OTHER	FL	BLUE CROSS

General Provider Information

NPI Number	:	1679543862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK M. RUSSO M.D.

Provider Business Mailing Address
First Line	:	P.O. BOX 551420
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33355-1420
Country	:	US
Telephone Number	:	800-243-3839
Fax Number	:	855-851-4405

Provider Business Practice Location Address
First Line	:	5352 LINTON BLVD.
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6514
Country	:	US
Telephone Number	:	561-498-1754
Fax Number	:	561-327-2674

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	03/21/2016

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