Healthcare Provider Details

I. General information

NPI: 1194778498
Provider Name (Legal Business Name): ORCAS ISLAND FAMILY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 MADRONA ST
EASTSOUND WA
98245-8573
US

IV. Provider business mailing address

PO BOX 1989
EASTSOUND WA
98245-1989
US

V. Phone/Fax

Practice location:
  • Phone: 360-376-4949
  • Fax: 833-992-2162
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID LEE RUSSELL
Title or Position: OWNER
Credential: MD
Phone: 360-376-4949