Individual
DR. JAMES MATTHEW RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 BARRS ST, DEPARTMENT OF RADIOLOGY, JACKSONVILLE, FL 32204-4704
(904) 388-1562
(904) 388-1841
Mailing address
PO BOX 161180, ALTAMONTE SPRINGS, FL 32716-1180
(904) 388-6949
(904) 388-1841
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME85677
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
093712752A
—
GA
05
—
279214100
—
FL
01
—
62682
BC BS OF FLORIDA
FL
01
—
P00428153
RR MEDICARE
FL
Enumeration date
11/21/2005
Last updated
08/14/2023
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