Individual
DR. PATRICK W RUSSELL
Active
Individual
DR. PATRICK W RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
02001219
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215919
BLUE SHIELD
IN
05
—
100114080
—
IN
01
—
130024231
MEDICARE RAILROAD
IN
Enumeration date
12/13/2005
Last updated
05/19/2023
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