Healthcare Provider Details

I. General information

NPI: 1447299987
Provider Name (Legal Business Name): DANIEL ELLIOTT ROUSSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 HIGHWAY 280 S SUITE 300-W
BIRMINGHAM AL
35223-2420
US

IV. Provider business mailing address

2700 HIGHWAY 280 S SUITE 300-W
BIRMINGHAM AL
35223-2420
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-9595
  • Fax: 205-802-7719
Mailing address:
  • Phone: 205-930-9595
  • Fax: 205-802-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: