Individual
PHILLIP G RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4721 W 6TH AVE STE 130, STILLWATER, OK 74074-1549
(405) 743-0550
Mailing address
4721 W 6TH AVE STE 130, STILLWATER, OK 74074-1549
(405) 743-0550
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
12288
OK
Other
Enumeration date
11/17/2005
Last updated
08/25/2020
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