Individual
MR. RICHARD DEWAYNE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3165 BOONE DR, CONWAY, AR 72034-7388
(501) 504-2126
(501) 504-2126
Mailing address
3165 BOONE DR, CONWAY, AR 72034-7388
(501) 504-2126
(501) 504-2126
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
MG00708
AR
Other
Enumeration date
01/06/2007
Last updated
07/09/2007
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