Individual
ROBERT C RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
320 E CARPENTER ST, SPRINGFIELD, IL 62702-5185
(217) 523-0808
(217) 753-5324
Mailing address
320 E CARPENTER ST, SPRINGFIELD, IL 62702-5185
(217) 523-0808
(217) 753-5324
Taxonomy
Speciality
Code
Description
License number
State
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
036061657
IL
208600000X
Surgery Physician
036061657
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
036061657
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036061657
—
IL
Enumeration date
05/31/2006
Last updated
03/21/2013
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