Healthcare Provider Details

I. General information

NPI: 1679543862
Provider Name (Legal Business Name): FRANK M. RUSSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5352 LINTON BLVD.
DELRAY BEACH FL
33484-6514
US

IV. Provider business mailing address

P.O. BOX 551420
FORT LAUDERDALE FL
33355-1420
US

V. Phone/Fax

Practice location:
  • Phone: 561-498-1754
  • Fax: 561-327-2674
Mailing address:
  • Phone: 800-243-3839
  • Fax: 855-851-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME78954
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: