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General NPI Number Information
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NPI Number | 1912355397
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Entity Type | Organization
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Legal Business Name | RUSSELL W. SAWYER, M.D. PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 141 LYNCH CREEK WAY SUITE A
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City | PETALUMA
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State | CA
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Zip | 94954-2341
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Country | US
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Telephone | 707-789-6300
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Fax | 707-789-6304
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Provider Business Mailing Address
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Address Line | 141 LYNCH CREEK WAY SUITE A
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City | PETALUMA
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State | CA
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Zip | 94954-2341
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Country | US
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Telephone | 707-789-6300
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Fax | 707-789-6304
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUSSELL WAYNE SAWYER
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Credential | M.D.
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Telephone | 707-789-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G66227
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License Number State | CA
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