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Organization

ROBERT C RUSSELL M D S C

Active
Other names
ROBERT C RUSSELL M D S C
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT C RUSSELL MD (OWNERPRESIDEN)
(217) 523-0808
Entity
Organization

Contact information

Practice address
320 E CARPENTER ST, SPRINGFIELD, IL 62702-5185
(217) 523-0808
(217) 753-5324
Mailing address
320 E CARPENTER ST, SPRINGFIELD, IL 62702-5185
(217) 523-0808
(217) 753-5324

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036061657
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036061657
IL
Enumeration date
10/14/2006
Last updated
03/21/2013
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