Healthcare Provider Details

I. General information

NPI: 1881646446
Provider Name (Legal Business Name): RUSSELL HOWARD SACHS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3052 US HIGHWAY 17 S
GREEN COVE SPRINGS FL
32043-9331
US

IV. Provider business mailing address

3061 ANDERSON RD
GREEN COVE SPRINGS FL
32043-9301
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-6069
  • Fax: 904-284-1515
Mailing address:
  • Phone: 904-284-7923
  • Fax: 903-285-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME45917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: