Individual
SHANE T RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6780 LOOP RD, DAYTON, OH 45459-2161
(937) 434-6344
Mailing address
6780 LOOP RD, DAYTON, OH 45459-2161
(937) 434-6344
(937) 434-9107
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
35086518
OH
Other
Enumeration date
07/11/2006
Last updated
12/03/2021
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