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General NPI Number Information
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NPI Number | 1538239546
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Entity Type | Individual
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Provider Name | MELVIN DAVID RUSSELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1200 ENCLAVE PKWY STE 200
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City | HOUSTON
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State | TX
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Zip | 77077-1733
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Country | US
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Telephone | 915-842-9705
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23188
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City | EL PASO
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State | TX
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Zip | 79923-0188
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Country | US
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Telephone | 915-842-9705
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | F4460
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License Number State | TX
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