Provider Demographics
NPI:1588762165
Name:LARUSSA, JOSEPH BRUNO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BRUNO
Last Name:LARUSSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 CENTRAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2506
Mailing Address - Country:US
Mailing Address - Phone:205-933-5599
Mailing Address - Fax:205-930-2611
Practice Address - Street 1:2908 CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-2506
Practice Address - Country:US
Practice Address - Phone:205-933-5599
Practice Address - Fax:205-930-2611
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00016064174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51039854OtherBLUE CROSS BLUE SHIELD
AL51039854OtherBLUE CROSS BLUE SHIELD
ALF51075Medicare UPIN