Doctor Name: | MIGUEL A LUNA RUSSO |
NPI Number: | 1538423967 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 23780 |
Business Practice Address: | 2500 N State St Department Of Obgyn Jackson, MS - 392164500 |
Business Phone Number: | 6019845338 |
Business Fax Number: | 6018154112 |
Mailing Address: | 1041s Madison St, TUPELO |
State: | MS |
Postal Code: | 388016309 |
Phone Number: | 6628446295 |
Fax Number: | 6628441973 |
NPI Enumeration Date: | 06/29/2012 |
NPI Last Update Date: | 08/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207V00000X |
License Number: | 23780 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ZZ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | |
Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |