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Individual

RHONDA A. RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
9202 ELAM RD, DALLAS, TX 75217-4151
(214) 266-1671
(214) 266-1829
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
J7782
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
124507807
TX
05
124507809
TX
05
124507811
TX
05
124507812
TX
05
124507813
TX
05
124507815
TX
05
124507817
TX
05
124507818
TX
05
124507819
TX
05
124507821
TX
05
124507823
TX
01
260051188
RAILROAD MEDICARE
TX
01
8080N3
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/07/2005
Last updated
07/25/2019
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