Individual
KIMBERLY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
35 PEARL ST STE 100, BROCKTON, MA 02301-2866
(508) 588-8034
(508) 588-5969
Mailing address
35 PEARL ST, STE 100, BROCKTON, MA 02301-2866
(508) 588-8034
(508) 588-5969
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
269874
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110102733A
—
MA
Enumeration date
04/19/2012
Last updated
04/17/2018
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