Individual
GARY D. RUSSELL
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
2525 E ROOSEVELT ST, PHOENIX, AZ 85008-4948
(602) 344-5651
(602) 344-5578
Mailing address
PO BOX 5177, PHOENIX, AZ 85010-5177
(602) 344-5651
(602) 344-5578
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1136
AZ
Other
Enumeration date
05/22/2006
Last updated
07/08/2007
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