MEDICARE: ROUSSO FACIAL PLASTIC SURGERY CLINIC PC

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	174400000X	Specialist	12459	AL

General Provider Information

NPI Number	:	1225140627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROUSSO FACIAL PLASTIC SURGERY CLINIC PC

Provider Business Mailing Address
First Line	:	2700 HIGHWAY 280 S
Second Line	:	SUITE 300 WEST
City	:	BIRMINGHAM
State	:	AL
Zip	:	35223-2420
Country	:	US
Telephone Number	:	205-930-9595
Fax Number	:	205-802-7719

Provider Business Practice Location Address
First Line	:	2700 HIGHWAY 280 S
Second Line	:	SUITE 300 WEST
City	:	BIRMINGHAM
State	:	AL
Zip	:	35223-2420
Country	:	US
Telephone Number	:	205-930-9595
Fax Number	:	205-802-7719

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. DANIEL E ROUSSO
Credential	:	M.D
Telephone Number	:	205-930-9595

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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