Individual
RICHARD L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
106 HIGHLAND WAY STE 200, MADISON, MS 39110-6933
(601) 200-4141
(601) 200-4150
Mailing address
PO BOX 23666, JACKSON, MS 39225-3666
(601) 200-4749
(601) 200-5929
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
14431
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126047
—
MS
Enumeration date
11/14/2006
Last updated
02/26/2019
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