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General NPI Number Information
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NPI Number | 1578786950
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Entity Type | Organization
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Legal Business Name | JAMES RUSSELL, M.D, INC.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 308 S MAIN ST
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City | SAPULPA
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State | OK
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Zip | 74066-4110
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Country | US
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Telephone | 918-224-3081
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Fax | 918-224-5059
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Provider Business Mailing Address
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Address Line | 308 S MAIN ST
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City | SAPULPA
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State | OK
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Zip | 74066-4110
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Country | US
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Telephone | 918-224-3081
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Fax | 918-224-5059
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES RUSSELL
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Credential | M.D.
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Telephone | 918-224-3081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13810
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License Number State | OK
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