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1861605487 NPI number — ROBERT RUEL RUSSELL DMD, MD

NPI Number: 1861605487
Health Care Provider/Practitioner: ROBERT RUEL RUSSELL DMD, MD

Information about “1861605487” NPI (ROBERT RUEL RUSSELL DMD, MD) exists in 1861605487 in HTML format HTML  |  1861605487 in plain Text format TXT  |  1861605487 in PDF (Portable Document Format) PDF  |  1861605487 in an XML format XML  formats.

NPI Number : 1861605487 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861605487",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUSSELL",
    "FirstName": "ROBERT",
    "MiddleName": "RUEL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DMD, MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "911 MAIN ST",
    "SecondLineMailingAddress": "SUITE 180",
    "MailingAddressCityName": "OREGON CITY",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97045-1867",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-650-6116",
    "MailingAddressFaxNumber": "503-650-6198",
    "FirstLinePracticeLocationAddress": "911 MAIN ST",
    "SecondLinePracticeLocationAddress": "SUITE 180",
    "PracticeLocationAddressCityName": "OREGON CITY",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97045-1867",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-650-6116",
    "PracticeLocationAddressFaxNumber": "503-650-6198",
    "EnumerationDate": "05/08/2007",
    "LastUpdateDate": "06/02/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "122300000X",
          "TaxonomyName": "Dentist",
          "LicenseNumber": "21510",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "204E00000X",
          "TaxonomyName": "Oral & Maxillofacial Surgery (D.M.D.)",
          "LicenseNumber": "MD28928",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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