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General NPI Number Information
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NPI Number | 1629305404
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Entity Type | Individual
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Provider Name | RUSSELL BENJAMIN EDWARDS DO
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Gender | Male
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 10840 TEXAS HEALTH TRL STE 250
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City | FORT WORTH
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State | TX
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Zip | 76244-6850
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Country | US
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Telephone | 817-750-1310
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Fax | 817-750-1311
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Provider Business Mailing Address
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Address Line | PO BOX 2078
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City | DECATUR
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State | TX
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Zip | 76234
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Country | US
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Telephone | 940-626-1905
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Fax | 940-626-1901
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | N1312
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License Number State | TX
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