Individual
DARIC J RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3385 POTOMAC WAY, IDAHO FALLS, ID 83404-4978
(208) 522-7246
(208) 529-2620
Mailing address
3385 POTOMAC WAY, IDAHO FALLS, ID 83404-4978
(208) 522-7246
(208) 529-2620
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
0-1036
ID
Other
Enumeration date
05/18/2012
Last updated
01/06/2020
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