Individual
MR. JONATHAN R. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10130 LOUETTA RD, SUITE G, HOUSTON, TX 77070-2118
(832) 698-5500
Mailing address
18220 STATE HIGHWAY 249 STE 200, HOUSTON, TX 77070-4370
(832) 698-5500
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
L0557
TX
207V00000X
Obstetrics & Gynecology Physician
Primary
L0557
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336142553
BLUE CROSS BLUE SHIELD
TX
05
—
143751903
—
TX
05
—
143751904
—
TX
01
—
8FX325
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/23/2005
Last updated
05/19/2025
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