Healthcare Provider Details

I. General information

NPI: 1497754477
Provider Name (Legal Business Name): JAMES BISHOP RUSSELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 06/27/2006

III. Provider practice location address

1014 HARKRIDER ST SUITE 3
CONWAY AR
72032
US

IV. Provider business mailing address

904 AUTUMN RD SUITE 500 PRACTICE PLUS
LITTLE ROCK AR
72211
US

V. Phone/Fax

Practice location:
  • Phone: 501-336-9733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberN7364
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: