Individual
DR. ROBERT L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
305 HIGHWAY 51, RIDGELAND, MS 39157-3428
(601) 856-9980
(601) 856-9994
Mailing address
5606 OLD CANTON RD, JACKSON, MS 39211-4217
(601) 856-9980
(601) 856-9994
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12039
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015413
—
MS
Enumeration date
10/02/2006
Last updated
02/06/2017
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