| Mr Peter Joseph Russo, PA | |
|
2545 W Hammer Ln, Stockton, CA 95209-2839 | |
| (209) 957-7050 | |
| Not Available |
| Full Name | Mr Peter Joseph Russo |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 2545 W Hammer Ln, Stockton, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588729941 | NPI | - | NPPES |
| CD069A | Other | CA | GROUP PTAN-GREATER MODESTO MEDICAL SURGICAL ASSOCIATES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | PA14699 (California) | Primary |
| 363AS0400X | Physician Assistant - Surgical | PA14699 (California) | Secondary |
| Entity Name | Sutter Valley Medical Foundation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1669846986 PECOS PAC ID: 9830094515 Enrollment ID: O20090311000335 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Peter Joseph Russo, PA 600 Coffee Rd, Modesto, CA 95355-4201 Ph: (209) 521-6097 | Mr Peter Joseph Russo, PA 2545 W Hammer Ln, Stockton, CA 95209-2839 Ph: (209) 957-7050 |
Christophe Thomas Anslinger, P.A.-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2488 N California St, Stockton, CA 95204 Phone: 209-948-3333 |
Stefan Jonathan Meers Estrada, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2505 W Hammer Ln, Stockton, CA 95209 Phone: 209-954-4040 Fax: 209-951-2239 |
Sabah Ayubyar, Physician Assistant Medicare: May Accept Medicare Assignments Practice Location: 1617 N California St, Stockton, CA 95204 Phone: 209-466-8546 |
Czarinabelle Perez, Physician Assistant Medicare: Medicare Enrolled Practice Location: 2626 N California St Ste B, Stockton, CA 95204 Phone: 209-466-2626 |
Mrs. Sandra Robles-bonham, P.A. Physician Assistant Medicare: Medicare Enrolled Practice Location: 77 W. March Lane, Suite A, Stockton, CA 95207 Phone: 209-477-5552 Fax: 209-477-5553 |
Stanley Ray Cathey, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 8719 Moreno Ct, Stockton, CA 95209 Phone: 209-269-0120 Fax: 209-476-1962 |
Kery Luo, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2505 W Hammer Ln, Stockton, CA 95209 Phone: 209-954-4040 Fax: 209-951-2239 |