MEDICARE: RUSSELL PHILIP LIBBY 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	208800000X	Urology Physician	S5214	TX

General Provider Information

NPI Number	:	1902216740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUSSELL PHILIP LIBBY MD

Provider Business Mailing Address
First Line	:	506 HUNTERS PARK LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-5411
Country	:	US
Telephone Number	:	404-909-5591
Fax Number	:

Provider Business Practice Location Address
First Line	:	24518 NORTHWEST FWY
Second Line	:	MEDICAL OFFICE BUILDING 2, SUITE 445
City	:	CYPRESS
State	:	TX
Zip	:	77429-2904
Country	:	US
Telephone Number	:	404-909-5591
Fax Number	:

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

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	06/02/2026

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