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General NPI Number Information
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NPI Number | 1053811273
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Entity Type | Individual
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Provider Name | JOSEPH THOMAS RUSSELL DO
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Gender | Male
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Dates
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Enumeration Date | 02/14/2018
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 504 LIPSCOMB ST
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City | BONHAM
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State | TX
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Zip | 75418-4028
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Country | US
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Telephone | 903-583-8585
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Fax |
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Provider Business Mailing Address
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Address Line | 504 LIPSCOMB ST
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City | BONHAM
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State | TX
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Zip | 75418-4028
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Country | US
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Telephone | 903-583-8585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6746
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | S3449
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License Number State | TX
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