Individual
CRAIG JENSEN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7556 HONEYSUCKLE, TEMPLE, TX 76502-5631
(254) 742-7400
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA15096
TX
Other
Enumeration date
11/11/2021
Last updated
02/22/2022
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