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NPI Code Detail

MEDICARE: DR. ALFRED JOHN RUSSO D.A.O.M., L.AC.

MEDICARE: DR. ALFRED JOHN RUSSO D.A.O.M., L.AC.
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
1171100000XAcupuncturist3036WA

General Provider Information

NPI Number : 1922323773
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALFRED JOHN RUSSO D.A.O.M., L.AC.
Provider Business Mailing Address
First Line : 3933 STONE WAY N
Second Line :
City : SEATTLE
State : WA
Zip : 98103-8017
Country : US
Telephone Number : 206-861-5580
Fax Number : 844-787-4718
Provider Business Practice Location Address
First Line : 3933 STONE WAY N
Second Line :
City : SEATTLE
State : WA
Zip : 98103-8017
Country : US
Telephone Number : 206-861-5580
Fax Number : 844-787-4718
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/05/2010
Last Update Date : 02/10/2016

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