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General NPI Number Information
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NPI Number | 1598962060
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Entity Type | Individual
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Provider Name | JEFFREY ROBERT RUSSO D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 12/09/2016
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Provider Practice Location Address
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Address Line | 212 NE NORTON LN
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City | MCMINNVILLE
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State | OR
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Zip | 97128-8470
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Country | US
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Telephone | 503-435-0130
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Fax | 503-435-0145
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Provider Business Mailing Address
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Address Line | 235 SE NORTON LN STE B
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City | MCMINNVILLE
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State | OR
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Zip | 97128-8479
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Country | US
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Telephone | 503-435-0130
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Fax | 503-435-0145
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP00326
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License Number State | OR
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