Healthcare Provider Details

I. General information

NPI: 1912260886
Provider Name (Legal Business Name): LLOYD W. RUSSELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2012
Last Update Date: 06/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 SIBLEY ST 1040
MONTROSE AL
36559-2100
US

IV. Provider business mailing address

7325 SIBLEY ST PO BOX 1040
MONTROSE AL
36559-2100
US

V. Phone/Fax

Practice location:
  • Phone: 251-401-3428
  • Fax:
Mailing address:
  • Phone: 251-401-3428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number2303
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2303
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: