Individual
RUSSELL LEE CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10058 SYLVARENA RD, WESSON, MS 39191-9055
(601) 757-5791
Mailing address
930 HIGH WILLOW DR, PROSPER, TX 75078-8322
(601) 757-5791
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15093
MS
Other
Enumeration date
01/13/2021
Last updated
01/13/2021
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