MEDICARE: DR. KAREN BULLOCK RUSSELL MD

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	207R00000X	Internal Medicine Physician	0101235467	VA
2	207RH0003X	Hematology & Oncology Physician	0101235467	VA
3	207RH0003X	Hematology & Oncology Physician	ME122150	FL

General Provider Information

NPI Number	:	1265492375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN BULLOCK RUSSELL MD

Provider Business Mailing Address
First Line	:	1775 ONE HEALING PL
Second Line	:	TMH PHYSICIAN PARTNERS, CANCER & HEMATOLOGY
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4600
Country	:	US
Telephone Number	:	850-431-5360
Fax Number	:	850-431-5367

Provider Business Practice Location Address
First Line	:	1775 ONE HEALING PL
Second Line	:	TMH PHYSICIAN PARTNERS, CANCER & HEMATOLOGY
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-4600
Country	:	US
Telephone Number	:	850-431-5360
Fax Number	:	850-431-5367

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	05/06/2015

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