MEDICARE: DR. ROBERT IRVING RUSSELL DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	94	AL
2	213E00000X	Podiatrist	94	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1201219	OTHER	AL	UNITED HEALTHCARE
2	697685	OTHER	AL	UHC GROUP

General Provider Information

NPI Number	:	1265420673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT IRVING RUSSELL DPM

Provider Business Mailing Address
First Line	:	1717 11TH AVE S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-4700
Country	:	US
Telephone Number	:	205-933-9595
Fax Number	:	205-933-5250

Provider Business Practice Location Address
First Line	:	1717 11TH AVE SOUTH
Second Line	:	SUITE 402
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-4700
Country	:	US
Telephone Number	:	205-933-9595
Fax Number	:	205-933-5250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	02/28/2013

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