Individual
DR. RUSS DEACON BIRDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3600 SHIRE BLVD, SUITE 104, RICHARDSON, TX 75082-2240
(972) 487-6400
(972) 487-1686
Mailing address
3600 SHIRE BLVD, SUITE 104, RICHARDSON, TX 75082-2240
(972) 487-6400
(972) 487-1686
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
G71405
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105418103
—
TX
Enumeration date
05/16/2006
Last updated
03/07/2022
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