Individual
CHRISTOPHER R RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2065 NE TUCSON WAY APT 110, BEND, OR 97701-5182
(541) 383-3005
(541) 383-1883
Mailing address
600 SW COLUMBIA ST STE 6250, BEND, OR 97702-1099
(541) 383-3005
(541) 383-1883
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01083
OR
363AM0700X
Medical Physician Assistant
AMD-445
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
695299
—
HI
Enumeration date
05/04/2006
Last updated
01/24/2023
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