Organization
GEORGE RAY RUSSELL MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE R RUSSELL MD (PRESIDENT)
(303) 444-4864
Entity
Organization
Contact information
Practice address
1000 ALPINE AVE, #50, BOULDER, CO 80304-3409
(303) 444-4864
(303) 444-4865
Mailing address
PO BOX 18058, BOULDER, CO 80308-1058
(303) 444-4864
(303) 444-4865
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
17600
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
84307366
—
CO
01
—
GE667695
BCBS OF CO GROUP #
CO
Enumeration date
05/29/2007
Last updated
05/07/2008
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