Individual
MARK D RUSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
767 WOOD AVE E, BIG STONE GAP, VA 24219-3023
(276) 523-1006
(276) 523-5293
Mailing address
PO BOX 857, BIG STONE GAP, VA 24219-3366
(276) 523-1006
(276) 523-5293
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101051554
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010092922
—
VA
05
—
Q51554
—
SC
Enumeration date
06/07/2006
Last updated
03/24/2009
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