Organization
JEREMY P. RUSSELL MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY P RUSSELL MD. (OWNER)
(256) 883-8087
Entity
Organization
Contact information
Practice address
4810 WHITESPORT CIR SW, SUITE 204, HUNTSVILLE, AL 35801-7419
(256) 883-8087
(256) 883-8284
Mailing address
4810 WHITESPORT CIR SW, SUITE 204, HUNTSVILLE, AL 35801-7419
(256) 883-8087
(256) 883-8284
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
26988
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558341123
INDIVIDUAL NPI
—
Enumeration date
05/03/2007
Last updated
08/22/2020
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