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NPI Code Detail

MEDICARE: DR. JOHN R. RUSSELL MD

MEDICARE: DR. JOHN R. 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
1207Q00000XFamily Medicine PhysicianC4971AR
2208M00000XHospitalist PhysicianC4971AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952380651
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN R. RUSSELL MD
Provider Business Mailing Address
First Line : 2918 LOUIS SESSIONS STREET
Second Line :
City : LAKE VILLAGE
State : AR
Zip : 71653
Country : US
Telephone Number : 870-265-5343
Fax Number : 870-265-5686
Provider Business Practice Location Address
First Line : 608 S HIGHWAY 65 82
Second Line :
City : LAKE VILLAGE
State : AR
Zip : 71653-1743
Country : US
Telephone Number : 870-265-9810
Fax Number : 870-265-9813
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 10/01/2024

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Directions to “ DR. JOHN R. RUSSELL MD” Practice Location

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