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General NPI Number Information
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NPI Number | 1336134188
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Entity Type | Individual
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Provider Name | BRUCE LYNN RUSSELL M.D. PLLC
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 111 BARTON HILL RD
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City | SCHOHARIE
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State | NY
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Zip | 12157-4806
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Country | US
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Telephone | 518-295-8521
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ATWELL RD
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City | COOPERSTOWN
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State | NY
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Zip | 13326
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Country | US
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Telephone | 607-547-3480
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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 | 187912
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G8391
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License Number State | TX
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