Individual
RENEE JEAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1110 NEO LOOP, GROVE, OK 74344-6046
(918) 786-3100
(918) 786-3108
Mailing address
1110 NEO LOOP, GROVE, OK 74344-6046
(918) 786-3100
(918) 786-3108
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22021
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100017290D
—
OK
05
—
100017290E
—
OK
Enumeration date
05/25/2006
Last updated
01/12/2017
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