MEDICARE: DAVID LEE 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	207Q00000X	Family Medicine Physician	MD00043008	WA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740233162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LEE RUSSELL MD

Provider Business Mailing Address
First Line	:	PO BOX 1989
Second Line	:
City	:	EASTSOUND
State	:	WA
Zip	:	98245-1989
Country	:	US
Telephone Number	:	360-376-4949
Fax Number	:	833-992-2162

Provider Business Practice Location Address
First Line	:	429 MADRONA ST
Second Line	:
City	:	EASTSOUND
State	:	WA
Zip	:	98245-8573
Country	:	US
Telephone Number	:	360-376-4949
Fax Number	:	833-992-2162

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/22/2025

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Directions to “ DAVID LEE RUSSELL MD” Practice Location

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