Organization
CHARLES B RUSSEY
Active
Other names
Acute Care and Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MS. HEATHER RENEE HARDIN (OFFICE MANAGER)
(814) 162-2221
Entity
Organization
Contact information
Practice address
480 W SOUTHLAKE BLVD, SUITE 115, SOUTHLAKE, TX 76092
(817) 416-2221
(817) 424-5400
Mailing address
480 W SOUTHLAKE BLVD, SUITE 115, SOUTHLAKE, TX 76092
(817) 416-2221
(817) 424-5400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K2373
TX
Other
Enumeration date
09/20/2006
Last updated
08/22/2020
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