Healthcare Provider Details

I. General information

NPI: 1336134188
Provider Name (Legal Business Name): BRUCE LYNN RUSSELL M.D. PLLC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 BARTON HILL RD
SCHOHARIE NY
12157-4806
US

IV. Provider business mailing address

1 ATWELL RD
COOPERSTOWN NY
13326
US

V. Phone/Fax

Practice location:
  • Phone: 518-295-8521
  • Fax:
Mailing address:
  • Phone: 607-547-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG8391
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number187912
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: