Individual
DANIEL RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 818-0563
(228) 818-0519
Mailing address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 818-0563
(228) 818-0519
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
R639869
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120416
—
MS
Enumeration date
11/07/2006
Last updated
06/13/2018
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