Organization
RUSSELL PERRY MD, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL MYRON PERRY MD (PRESIDENT/OWNER)
(707) 261-7880
Entity
Organization
Contact information
Practice address
700 RIVER DR, FORT BRAGG, CA 95437-5403
(707) 961-4665
(707) 961-4780
Mailing address
PO BOX 3222, NAPA, CA 94558-0293
(707) 261-7824
(707) 256-3508
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G428120
—
CA
01
—
DA6000
RAILROAD MEDICARE PIN
—
Enumeration date
05/27/2006
Last updated
09/05/2013
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