Individual
DR. RUSSELL W NELLIGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 US HIGHWAY 1 S, ST AUGUSTINE, FL 32084-4211
(904) 829-2286
(904) 810-5687
Mailing address
1400 US HIGHWAY 1 S, ST AUGUSTINE, FL 32084-4211
(904) 829-2286
(904) 810-5687
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
N5906
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07877
—
LA
Enumeration date
05/25/2007
Last updated
05/02/2013
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