Individual
KEVIN LEIGH RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
MSRON-6, BLDG 15, NORFOLK NAVAL SHIPYARD, PORTSMOUTH, VA 23709
(757) 967-4177
Mailing address
MSRON-6, BLDG 15, NORFOLK NAVAL SHIPYARD, PORTSMOUTH, VA 23709
(757) 967-4177
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
08/06/2009
Last updated
08/06/2009
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