Healthcare Provider Details

I. General information

NPI: 1114902525
Provider Name (Legal Business Name): RUSSELL C SEXTON JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 FM 1960 RD W STE 206
HOUSTON TX
77090-3408
US

IV. Provider business mailing address

17080 RED OAK DR
HOUSTON TX
77090-2602
US

V. Phone/Fax

Practice location:
  • Phone: 281-880-6991
  • Fax: 281-880-6994
Mailing address:
  • Phone: 281-880-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberOS9472
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberTEMP
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: