Individual
DR. REX TREVOR RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
D61674
MD
207L00000X
Anesthesiology Physician
Primary
M6369
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
189456005
—
TX
05
—
408659700
—
MD
01
—
8EH105
BCBS
TX
01
—
P01446716
RR
TX
Enumeration date
06/28/2006
Last updated
08/16/2022
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