MEDICARE: TERRI ANNE 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	H4663	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E73457	OTHER	TX	UPIN

General Provider Information

NPI Number	:	1760652770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRI ANNE RUSSELL, MD

Provider Business Mailing Address
First Line	:	811 E 32ND ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2507
Country	:	US
Telephone Number	:	512-467-7111
Fax Number	:	512-467-8482

Provider Business Practice Location Address
First Line	:	811 E 32ND ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2507
Country	:	US
Telephone Number	:	512-467-7111
Fax Number	:	512-467-8482

Authorized Official
Title or Position	:	BILLING MGR
Name	:	MRS. TERRI R LAWS
Credential	:
Telephone Number	:	512-467-7111

Provider Enumeration Date	:	03/05/2008
Last Update Date	:	03/05/2008

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