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General NPI Number Information
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NPI Number | 1922560648
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Entity Type | Individual
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Provider Name | ADAM KELSEY RUSSON DO
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Gender | Male
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 2310 CORPORATE CIR STE 200
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City | HENDERSON
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State | NV
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Zip | 89074-7729
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Country | US
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Telephone | 702-735-8000
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Fax | 702-563-2937
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Provider Business Mailing Address
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Address Line | 7500 SMOKE RANCH RD STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89128-0373
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Country | US
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Telephone | 702-233-0727
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | DO3718
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License Number State | NV
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