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General NPI Number Information
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NPI Number | 1366496457
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Entity Type | Individual
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Provider Name | RUSSELL ALAN CHEANEY MD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 03/20/2019
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Provider Practice Location Address
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Address Line | 3333 CATTLEMEN RD STE 100
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City | SARASOTA
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State | FL
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Zip | 34232-6057
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Country | US
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Telephone | 941-379-5884
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 890561
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City | CHARLOTTE
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State | NC
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Zip | 28289-0561
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Country | US
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Telephone | 800-919-1190
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Fax | 706-737-2272
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 29897
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME138842
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License Number State | FL
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