Individual
DR. NATHAN E RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
37100 N GANTZEL RD STE 201A, SAN TAN VALLEY, AZ 85140-7352
(480) 394-4469
Mailing address
37100 N GANTZEL RD STE 201A, SAN TAN VALLEY, AZ 85140-7352
(480) 394-4469
(480) 394-4520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
59940
AZ
208M00000X
Hospitalist Physician
59940
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2017
Last updated
01/26/2021
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