=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326038662
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD WAYNE RUSSELL M. D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2005
-----------------------------------------------------
Last Update Date | 11/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 MCDOWELL ST
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-255-3749
-----------------------------------------------------
Fax | 828-254-9925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2445
-----------------------------------------------------
City | SKYLAND
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28776-2445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-575-2644
-----------------------------------------------------
Fax | 828-350-2174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207K00000X
-----------------------------------------------------
Taxonomy Name | Allergy & Immunology Physician
-----------------------------------------------------
License Number | 38683
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------