Healthcare Provider Details

I. General information

NPI: 1346430030
Provider Name (Legal Business Name): PATRICK WINSTON RUSSELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2007
Last Update Date: 07/21/2022
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 N FRANKLIN ST
DENVER CO
80205-5437
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number53049-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberDR.0051431
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: