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General NPI Number Information
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NPI Number | 1598738874
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Entity Type | Individual
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Provider Name | EDMOND V RUSS III MD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 1725 HARRODSBURG RD STE 100
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City | LEXINGTON
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State | KY
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Zip | 40504-3601
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Country | US
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Telephone | 859-278-7226
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Fax | 859-276-1540
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Provider Business Mailing Address
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Address Line | 1725 HARRODSBURG RD STE 100
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City | LEXINGTON
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State | KY
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Zip | 40504-3601
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Country | US
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Telephone | 859-278-7226
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Fax | 859-276-1540
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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 | 53439
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 35082471R
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License Number State | OH
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