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RUSSELL ALEXANDER SHATFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
315 E BROADWAY, SUITE 195, LOUISVILLE, KY 40202-3700
(502) 629-4263
(502) 629-4282
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116

Taxonomy

Speciality
Code
Description
License number
State
2086S0105X
Surgery of the Hand (Surgery) Physician
Primary
30782
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000694192
ANTHEM - LAH
KY
01
000057058U
HUMANA - LAH
KY
01
121306
SIHO - LAH
KY
01
4632527
CIGNA - LAH
KY
01
50030992
PASSPORT/PASSPORT ADVANTAGE - LAH
KY
05
64307820
KY
Enumeration date
10/31/2006
Last updated
09/27/2024
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