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General NPI Number Information
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NPI Number | 1770565087
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Entity Type | Individual
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Provider Name | TIMOTHY PAUL RUSSELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2005
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | UNIT 45011 BLDG 704, ATTN: MCJA-QM USA MEDDAC-JAPAN
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City | APO
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State | AP
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Zip | 96338-5011
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Country | US
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Telephone | 011813117
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Fax | 4127
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Provider Business Mailing Address
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Address Line | UNIT 45013 BOX 2884
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City | APO
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State | AP
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Zip | 96338-5013
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Country | US
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Telephone | 011813117
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Fax | 4127
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 21584-020
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License Number State | WI
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