Individual
JEFFREY DANE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
900 CATON AVE, BALTIMORE, MD 21229-5201
(410) 368-2000
Mailing address
2100 POWELL ST, SUITE 900, EMERYVILLE, CA 94608-1826
(510) 350-2600
(510) 879-9084
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0005160
MD
Other
Enumeration date
09/26/2013
Last updated
09/26/2013
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