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General NPI Number Information
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NPI Number | 1780027268
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Entity Type | Individual
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Provider Name | RUSSELL D JAPIKSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 700 WEST AVE S
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City | LA CROSSE
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State | WI
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Zip | 54601-4783
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Country | US
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Telephone | 608-785-0940
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Fax |
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Provider Business Mailing Address
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Address Line | 1632 E NORTHWOOD DR
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City | HAYDEN LAKE
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State | ID
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Zip | 83835-8582
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Country | US
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Telephone | 585-857-9042
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 63155-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 143275
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 51817
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M-13292
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License Number State | ID
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