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Individual

DR. ROBERT JOSEPH RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
539C HIGHWAY 80 W, CLINTON, MS 39056-4193
(601) 924-7489
(601) 924-0988
Mailing address
1867 CRANE RIDGE DR STE 101B, JACKSON, MS 39216-4956
(601) 362-8776
(601) 354-8786

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
14410
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0119425
MS
Enumeration date
08/31/2006
Last updated
07/08/2007
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