MEDICARE: RUSSELL K BRYNES 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	G26576	CA

General Provider Information

NPI Number	:	1518972223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL K BRYNES MD

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	323-442-2582
Fax Number	:	323-442-2588

Provider Business Practice Location Address
First Line	:	2011 ZONAL AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0110
Country	:	US
Telephone Number	:	323-442-2582
Fax Number	:	323-442-2588

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	11/27/2023

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