Active NPI
Ethan Budd Russo
- Neurology Physician
- Vashon, WA
National Provider Identifier
1760024632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 00018304
- Practice address
- 20402 81St Avenue SW
Vashon, WA 98070-6253 - Phone
- (206) 304-4344
- NPI assigned
- Oct 12, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 00018304 | WA | Primary |
Addresses
Primary practice location
20402 81St Avenue SW
Vashon, WA 98070-6253
Mailing address
20402 81St Avenue SW
Vashon, WA 98070-6253
Phone (206) 304-4344
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00018304 | Other | WA | WASHINGTON STATE MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00018304 | WA | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570838400000",
"number": "1760024632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20402 81ST AVENUE SW",
"city": "VASHON",
"state": "WA",
"postal_code": "980706253",
"telephone_number": "206-304-4344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20402 81ST AVENUE SW",
"city": "VASHON",
"state": "WA",
"postal_code": "980706253",
"telephone_number": "206-304-4344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSO",
"first_name": "ETHAN",
"middle_name": "BUDD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-10-12",
"last_updated": "2019-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "WA",
"license": "00018304",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE MEDICAL LICENSE",
"identifier": "00018304",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vashon, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.