PETER DAMON RUSSOTTO (NPI# 1770576829) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770576829 |
| Entity Type | Individual |
| Full Name | PETER DAMON RUSSOTTO |
| Credential | DPM |
| Practice Address |
1440 W Walnut St #5 Jacksonville IL 62650-1143 |
| Practice Telephone | 2172433668 |
| Mailing Telephone | 2172433668 |
| Mailing Fax Number | 2172451923 |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 213E00000X | Podiatrist | IL | Podiatric Medicine & Surgery Service Providers |
| Street Address |
1440 W WALNUT ST #5 |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-1143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972023117 | Ethan Duewer | Dentist | 1440 W Walnut St, Jacksonville, IL 62650-1143 | 2017-06-20 |
| 1205282936 | Central Counties Health Centers, Inc. | Physician Assistant | 1440 W Walnut St, Suite 2, Jacksonville, IL 62650-1143 | 2016-05-12 |
| 1114322286 | Jersey Community Hospital | Pediatrics | 1440 W Walnut St, Suite 2a, Jacksonville, IL 62650-1143 | 2014-10-30 |
| 1891034294 | Illini Medical Associates, Sc | Pediatrics | 1440 W Walnut St, Ste 2a, Jacksonville, IL 62650-1143 | 2013-02-05 |
| 1558480418 | Physical Therapists Clinic,ltd | Clinic/Center | 1440 W Walnut St, Suite 2, Jacksonville, IL 62650-1143 | 2007-03-29 |
| 1083769475 | Physical Therapists Clinic, Ltd | Physical Therapist | 1440 W Walnut St, Suite2, Jacksonville, IL 62650-1143 | 2007-01-24 |
| 1174608533 | Donald Robert Beckett Jr. | Dentist | 1440 W Walnut St, Suite 2, Jacksonville, IL 62650 | 2006-10-26 |
| 1336179712 | Amy Jo Blanford | Physical Therapist | 1440 W Walnut St, Building #2, Jacksonville, IL 62650-1143 | 2006-07-03 |
| 1245203439 | Linda V Stevens-schilsky | Pediatrics | 1440 W Walnut St, Jacksonville, IL 62650 | 2006-02-09 |
| 1043299803 | Abby G Henry | Physical Therapist | 1440 W Walnut St, #2, Jacksonville, IL 62650-1143 | 2006-01-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
| 1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
| 1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
| 1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
| 1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
| 1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
| 1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
| 1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
| Find all providers in zip 62650 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487146890 | First Coast Medical Network LLC | Podiatrist | 2645 Cody Dr, Jacksonville, FL 32223-5585 | 2018-05-31 |
| 1023461480 | Cynthia Correa-cedeno | Podiatrist | 14011 Beach Blvd Ste 220, Jacksonville, FL 32250-1695 | 2016-07-20 |
| 1083029698 | Norshae Robinson | Podiatrist | Total Foot Care and Wellness Clinic, 8613 Old Kings Rd South, Suite 301, Jacksonville, FL 32217-4845 | 2014-06-23 |
| 1457529976 | Earl Horowitz Dpm Pa | Podiatrist | 2236 Park St, Jacksonville, FL 32204-4316 | 2008-02-19 |
| 1992838296 | Howard G Groshell Jr. | Podiatrist | 2236 Park Street, Jacksonville, FL 32204-4316 | 2007-03-14 |
| 1356400642 | Smita Malhotra Dpm Pa | Podiatrist | 4213 Metron Dr, Jacksonville, FL 32216-1012 | 2006-12-06 |
| 1457432387 | Podiatry Associates of Florida Inc | Podiatrist | 5911 Timuquana Rd Unit 300, Jacksonville, FL 32210 | 2006-10-18 |
| 1154432219 | Earl R Horowitz D P M Pa | Podiatrist | 2550 Park St, Jacksonville, FL 32204-4518 | 2006-08-31 |
| 1942319645 | Jeffrey L Burmeister | Podiatrist | 2762 Dunn Ave, Jacksonville, FL 32218-4659 | 2006-08-29 |
| 1306871827 | Theodore Joseph Piano | Podiatrist | 4142 Hanging Moss Ct, Jacksonville, FL 32257-7658 | 2006-07-12 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
Please comment or provide details below to improve the information on PETER DAMON RUSSOTTO.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.