Individual
DR. JASON LUTHER RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
332 CONGRESS PARK DR, DAYTON, OH 45459-4133
(937) 312-3627
Mailing address
332 CONGRESS PARK DR, DAYTON, OH 45459-4133
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
34-009466
OH
207P00000X
Emergency Medicine Physician
5101027902
MI
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
Primary
34-009466
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2935042
—
OH
Enumeration date
05/09/2007
Last updated
04/15/2024
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