Individual
RUSSELL SHULTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-0000
Mailing address
600 MOORLAND DR, JOHNSON CITY, TN 37604-4424
(865) 322-0874
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
042-0014896
VT
390200000X
Student in an Organized Health Care Education/Training Program
—
VT
Other
Enumeration date
05/09/2016
Last updated
10/22/2020
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