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NPI Code Detail

MEDICARE: JOSHUA AARON RUSSELL DO

MEDICARE: JOSHUA AARON RUSSELL DO
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
1207Q00000XFamily Medicine PhysicianOS19154FL
2208M00000XHospitalist PhysicianOS19154FL
3208M00000XHospitalist PhysicianV7777TX
4207Q00000XFamily Medicine Physician34C.000622OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396236469
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSHUA AARON RUSSELL DO
Provider Business Mailing Address
First Line : 205 TRINITY WAY
Second Line :
City : ST JOHNS
State : FL
Zip : 32259-1155
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 205 TRINITY WAY
Second Line :
City : ST JOHNS
State : FL
Zip : 32259-1155
Country : US
Telephone Number : 904-691-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2018
Last Update Date : 02/05/2026

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