Individual
DR. WESLEY ALAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11050 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845
(260) 266-9100
(260) 266-9110
Mailing address
7910 W JEFFERSON BLVD, SUITE 110, FORT WAYNE, IN 46804-4159
(260) 436-4116
(260) 459-2504
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
01072532A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0083773
—
OH
05
—
1508029497
—
MI
05
—
201163340
—
IN
Enumeration date
07/09/2008
Last updated
06/15/2018
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