MEDICARE: DR. STEPHEN RUSSELL DEPUTY 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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	12224R	LA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932137064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN RUSSELL DEPUTY MD

Provider Business Mailing Address
First Line	:	1340 POYDRAS ST
Second Line	:	SUITE 1640
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-1221
Country	:	US
Telephone Number	:	504-412-1835
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 POYDRAS ST
Second Line	:	SUITE 1640
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-1221
Country	:	US
Telephone Number	:	504-412-1835
Fax Number	:

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	02/06/2012

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