Individual
GUY R. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1414 N CALIFORNIA ST, STOCKTON, CA 95202-1515
(209) 468-2385
(209) 468-8024
Mailing address
4165 FORT DONELSON DR, STOCKTON, CA 95219-3218
(209) 472-0755
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G19779
CA
Other
Enumeration date
10/24/2006
Last updated
07/08/2007
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