Individual
DR. GEORGE V RUSSELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
Primary
16970
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120719
—
MS
05
—
192085
—
AL
01
—
512G700003
MEDICARE UP
MS
01
—
512I200009
PTAN UP
MS
01
—
P00628048
RAILROAD MEDICARE PTAN#
MS
Enumeration date
06/09/2005
Last updated
01/25/2024
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