MEDICARE: DR. DALLAS M 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	174400000X	Specialist	12098	AL
2	2084N0400X	Neurology Physician	12098	AL

Other Identifiers

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

General Provider Information

NPI Number	:	1609879253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALLAS M RUSSELL MD

Provider Business Mailing Address
First Line	:	790 MONTCLAIR RD
Second Line	:	STE 210
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1966
Country	:	US
Telephone Number	:	205-595-3600
Fax Number	:	205-595-3663

Provider Business Practice Location Address
First Line	:	790 MONTCLAIR RD
Second Line	:	STE 210
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1966
Country	:	US
Telephone Number	:	205-595-3600
Fax Number	:	205-595-3663

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	03/20/2008

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Directions to “ DR. DALLAS M RUSSELL MD” Practice Location

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