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Individual

DR. RUSSELL SCOTT KIZOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3134
(207) 662-0111
Mailing address
6 GLEN COVE DR, ROCKPORT, ME 04856-4272
(207) 301-8000

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD24888
ME
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1548792344
ME
Enumeration date
03/30/2017
Last updated
01/07/2022
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