Individual
RUSSELL DENEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4102 A1A S, SAINT AUGUSTINE, FL 32080-6942
(904) 471-1300
(904) 471-1333
Mailing address
4102 A1A S, SAINT AUGUSTINE, FL 32080-6942
(904) 471-1300
(904) 471-1333
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
195944
NY
2084P0800X
Psychiatry Physician
Primary
ME121648
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
960396
MVP
NY
01
—
B56MB
FLORIDA BLUE
FL
Enumeration date
06/21/2006
Last updated
03/17/2018
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