Individual
DR. LINCOLN DAVID RUSSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 MISSION BLVD, JACKSON, CA 95642-2564
(209) 223-0949
(209) 223-0965
Mailing address
PO BOX 877, JACKSON, CA 95642-0877
(209) 223-0949
(209) 223-0965
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G86200
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0043480
—
CA
Enumeration date
02/02/2007
Last updated
12/18/2007
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