Healthcare Provider Details

I. General information

NPI: 1740233162
Provider Name (Legal Business Name): DAVID LEE RUSSELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

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: 360-376-4949
  • Fax: 833-992-2162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00043008
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: