Individual
DONALD J RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4525 CAMERON VALLEY PKWY, SUITE 3100, CHARLOTTE, NC 28211-4369
(704) 302-9300
(704) 302-9301
Mailing address
PO BOX 601643, CHARLOTTE, NC 28260-1643
(704) 302-9300
(704) 302-9301
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19188
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193375
—
SC
01
—
74036
BCBS OF NC
NC
05
—
8974036
—
NC
Enumeration date
07/18/2006
Last updated
08/26/2014
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