Individual
DR. STEVEN RICHARD RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10285 RIDGE RD, WHEAT RIDGE, CO 80033-2301
(303) 463-2620
(303) 463-2651
Mailing address
10285 RIDGE RD, WHEAT RIDGE, CO 80033-2301
(303) 463-2620
(303) 463-2650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35854
CO
207QS0010X
Sports Medicine (Family Medicine) Physician
35854
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01358548
—
CO
01
—
C547738
MEDICARE TYPE UNSPECIFIED
CO
Enumeration date
05/16/2006
Last updated
06/23/2010
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