Individual
DR. RUSSELL WELDON MAYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
730 N COLLEGE RD, SUITE B, TWIN FALLS, ID 83301-3382
(208) 814-7350
(208) 732-8508
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 814-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
5101015814
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808041500
—
ID
01
—
P00654616
MCRR
ID
Enumeration date
04/13/2007
Last updated
12/29/2014
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