Individual
MR. JAMES RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
308 S MAIN ST, SAPULPA, OK 74066-4110
(918) 224-3081
(918) 224-5059
Mailing address
308 S MAIN ST, SAPULPA, OK 74066-4110
(918) 224-3081
(918) 224-5059
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13810
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100134450A
—
OK
01
—
100134450B
SOONERCARE
—
Enumeration date
10/03/2006
Last updated
06/09/2010
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