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General NPI Number Information
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NPI Number | 1366649790
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Entity Type | Individual
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Provider Name | CRYSTAL RUSSELL MD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 6000 HIGHWAY 98
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City | PENSACOLA
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State | FL
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Zip | 32512-1098
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Country | US
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Telephone | 850-505-6532
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 HIGHWAY 98
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City | PENSACOLA
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State | FL
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Zip | 32512-0001
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Country | US
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Telephone | 617-501-0578
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101244160
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License Number State | VA
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