Provider Demographics
NPI:1447299987
Name:ROUSSO, DANIEL ELLIOTT (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ELLIOTT
Last Name:ROUSSO
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 1:2700 HIGHWAY 280 S
Mailing Address - Street 2:SUITE 300-W
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2420
Mailing Address - Country:US
Mailing Address - Phone:205-930-9595
Mailing Address - Fax:205-802-7719
Practice Address - Street 1:2700 HIGHWAY 280 S
Practice Address - Street 2:SUITE 300-W
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2420
Practice Address - Country:US
Practice Address - Phone:205-930-9595
Practice Address - Fax:205-802-7719
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC75698Medicare UPIN