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General NPI Number Information
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NPI Number | 1962408658
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Entity Type | Individual
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Provider Name | DUANE L. RUSSELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 117 S 11TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-4312
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Country | US
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Telephone | 601-425-3033
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Fax | 601-428-6561
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Provider Business Mailing Address
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Address Line | 117 S 11TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-4312
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Country | US
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Telephone | 601-425-3033
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Fax | 601-428-6561
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 017375
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License Number State | MS
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