Individual
RICHARD R RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1915 W 5950 S, ROY, UT 84067-1454
(801) 387-8100
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-8100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1016831206
UT
Other
Enumeration date
07/25/2006
Last updated
07/09/2008
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