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General NPI Number Information
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NPI Number | 1386078582
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Entity Type | Individual
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Provider Name | RICHARD F RUSSELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/25/2013
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Last Update Date | 08/25/2013
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Provider Practice Location Address
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Address Line | 2221 S TIOGA WAY
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City | LAS VEGAS
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State | NV
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Zip | 89117-2735
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Country | US
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Telephone | 702-256-9666
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Fax | 702-256-6676
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Provider Business Mailing Address
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Address Line | 2221 S TIOGA WAY
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City | LAS VEGAS
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State | NV
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Zip | 89117-2735
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Country | US
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Telephone | 702-256-9666
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Fax | 702-256-6676
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5521
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License Number State | NV
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