Individual
RUSSELL B STAPLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 S 18TH ST STE 202, FERNANDINA BEACH, FL 32034-4729
(904) 261-9786
(904) 376-3203
Mailing address
PO BOX 746652, ATLANTA, GA 30374-6652
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
ME69903
FL
207RI0011X
Interventional Cardiology Physician
ME69903
FL
207UN0901X
Nuclear Cardiology Physician
Primary
ME69903
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060071306
RAILROAD MEDICARE
FL
05
—
250604100
—
FL
Enumeration date
04/21/2006
Last updated
11/06/2025
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