Individual
BYRON DALE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
907 GEORGIANA ST, PORT ANGELES, WA 98362-3911
(360) 565-0999
(360) 565-9251
Mailing address
PO BOX 850, PORT ANGELES, WA 98362-0146
(360) 565-0999
(360) 565-9251
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD00025573
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
561060
—
AZ
Enumeration date
06/17/2005
Last updated
07/19/2017
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