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Individual
RUSSELL G. HISSCOCK
Active
Individual
RUSSELL G. HISSCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A10268
CA
207Q00000X
Family Medicine Physician
4374
AZ
207Q00000X
Family Medicine Physician
OP60690694
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109455
—
AZ
01
—
363180
STATE L&I
WA
Enumeration date
08/20/2006
Last updated
10/22/2019
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