Organization
RUSSELL EMERGENCY PHYSICIANS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY BYRNE M.D., (PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
201 14TH ST SW, LARGO, FL 33770-3133
(727) 588-5222
(727) 588-5458
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21749
BLUE SHIELD
FL
05
—
264169100
—
FL
Enumeration date
05/08/2006
Last updated
12/24/2013
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