Individual
MR. GYLES DONALD RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
800 OAK RIDGE TPKE, SUITE C 102, OAK RIDGE, TN 37830-6957
(865) 483-7790
(865) 483-7791
Mailing address
116 DARTMOUTH CIR, OAK RIDGE, TN 37830-7703
(865) 483-6850
(865) 483-7791
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT 157
TN
Other
Enumeration date
12/20/2006
Last updated
07/08/2007
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