Individual
SHANE B RUSSELL-JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2555 E GILA RIDGE RD, YUMA, AZ 85365-2240
(928) 317-9972
Mailing address
2555 E GILA RIDGE RD, YUMA, AZ 85365-2240
(928) 317-9972
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD2004-0132
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
77456581
—
NM
Enumeration date
08/31/2006
Last updated
09/09/2010
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