Individual
MR. CHARLES BYROM RUSSEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
480 W SOUTHLAKE BLVD, STE 115, SOUTHLAKE, TX 76092-6162
(817) 416-2221
(817) 424-5400
Mailing address
480 W SOUTHLAKE BLVD, STE 115, SOUTHLAKE, TX 76092-6162
(817) 416-2221
(817) 424-5400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K2373
TX
Other
Enumeration date
08/19/2005
Last updated
07/08/2007
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