MEDICARE: DR. RICHARD F RUSSELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	5521	NV

General Provider Information

NPI Number	:	1386078582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD F RUSSELL M.D.

Provider Business Mailing Address
First Line	:	2221 S TIOGA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2735
Country	:	US
Telephone Number	:	702-256-9666
Fax Number	:	702-256-6676

Provider Business Practice Location Address
First Line	:	2221 S TIOGA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2735
Country	:	US
Telephone Number	:	702-256-9666
Fax Number	:	702-256-6676

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2013
Last Update Date	:	08/25/2013

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