Individual
JEFFREY W RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
85 N GRAND AVE, 2ND FLOOR, FORT THOMAS, KY 41075-1793
(859) 781-2628
(859) 572-4403
Mailing address
85 N GRAND AVE, 2ND FLOOR, FORT THOMAS, KY 41075-1793
(859) 781-2628
(859) 572-4403
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
21322
KY
208600000X
Surgery Physician
35037666R
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2564238
—
OH
05
—
64213226
—
KY
Enumeration date
04/25/2006
Last updated
10/22/2012
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