MEDICARE: DR. CHARLES RAYFIELD RUSSELL III M.D.

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	207R00000X	Internal Medicine Physician	ME152163	FL
2	207RN0300X	Nephrology Physician	ME152163	FL
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	ME152163	FL
4	390200000X	Student in an Organized Health Care Education/Training Program

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	:	1922539857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES RAYFIELD RUSSELL III M.D.

Provider Business Mailing Address
First Line	:	3 SHIRCLIFF WAY STE 625
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4776
Country	:	US
Telephone Number	:	904-308-6900
Fax Number	:	904-308-6927

Provider Business Practice Location Address
First Line	:	3 SHIRCLIFF WAY STE 625
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4776
Country	:	US
Telephone Number	:	904-308-6900
Fax Number	:	904-308-6927

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

Provider Enumeration Date	:	03/22/2017
Last Update Date	:	02/26/2026

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