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Individual
ALEXANDER S RUSSELL
Active
Individual
ALEXANDER S RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
50.005155RX
OH
363A00000X
Physician Assistant
Primary
5601008724
MI
Other
Enumeration date
07/28/2017
Last updated
07/25/2018
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