Individual
DEIDRE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21300 N JOHN WAYNE PKWY STE 121, MARICOPA, AZ 85139-8978
(480) 821-3600
(480) 857-2667
Mailing address
PO BOX 6730, CHANDLER, AZ 85246-6730
(480) 821-3600
(480) 857-2667
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
48632
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
906341
—
AZ
Enumeration date
08/16/2006
Last updated
11/27/2023
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