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General NPI Number Information
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NPI Number | 1467872127
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Entity Type | Individual
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Provider Name | WILLIAM RUSSELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 4327 BARNETT RD
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City | WICHITA FALLS
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State | TX
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Zip | 76310
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Country | US
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Telephone | 940-764-5200
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Fax | 940-764-5201
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Provider Business Mailing Address
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Address Line | PO BOX 9261
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City | WICHITA FALLS
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State | TX
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Zip | 76308-9261
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Country | US
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Telephone | 940-764-7230
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Fax | 940-764-7255
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R0787
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License Number State | TX
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