Healthcare Provider Details

I. General information

NPI: 1932197241
Provider Name (Legal Business Name): JAMES L RUSSELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TOWSON AVE
FORT SMITH AR
72901
US

IV. Provider business mailing address

3820 FREE FERRY RD
FORT SMITH AR
72903-1762
US

V. Phone/Fax

Practice location:
  • Phone: 479-441-4000
  • Fax:
Mailing address:
  • Phone: 479-462-2932
  • Fax: 479-441-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-3810
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3810
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: