Individual
SCOTT RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
700 W 7TH AVE STE 103, BRISTOW, OK 74010-2302
(918) 582-1980
(918) 561-1289
Mailing address
1145 S UTICA AVE STE 110, TULSA, OK 74104-4013
(918) 579-3825
(918) 579-1262
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6747
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/28/2018
Last updated
05/06/2021
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