MEDICARE: SCOTT ANTHONY 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	208600000X	Surgery Physician	H4662	TX

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	4232187	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1790781706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ANTHONY RUSSELL MD

Provider Business Mailing Address
First Line	:	7200 WYOMING SPGS
Second Line	:	STE 500
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-4307
Country	:	US
Telephone Number	:	512-244-0111
Fax Number	:	512-244-2479

Provider Business Practice Location Address
First Line	:	3201 S AUSTIN AVE
Second Line	:	STE 330
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-7545
Country	:	US
Telephone Number	:	512-864-3183
Fax Number	:	512-930-3409

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	09/29/2010

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