Individual
DR. JOHN MICHAEL RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
315 PALM COAST PKWY NE, SUITE 3, PALM COAST, FL 32137-3888
(386) 447-4440
(386) 447-4446
Mailing address
315 PALM COAST PKWY NE, SUITE 3, PALM COAST, FL 32137-3888
(386) 447-4440
(386) 447-4446
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME57356
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252330200
—
FL
Enumeration date
08/30/2005
Last updated
08/22/2007
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