Organization
DAVID JOSEPH RUSSELL MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J RUSSELL MD (OWNER)
(541) 274-2894
Entity
Organization
Contact information
Practice address
2200 BRYANT WILLIAMS DR, KLAMATH FALLS, OR 97601-1120
(541) 274-2894
(541) 274-3392
Mailing address
PO BOX 5109, KLAMATH FALLS, OR 97601-0119
(541) 882-1540
(541) 882-2583
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD28531
OR
2086S0129X
Vascular Surgery Physician
MD28531
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024212
—
OR
Enumeration date
07/15/2008
Last updated
10/13/2008
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