Individual
JUSTIN LEE RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
11505 RANGELAND PKWY, BRADENTON, FL 34211-4041
(941) 362-8662
(941) 362-8602
Mailing address
11505 RANGELAND PKWY, BRADENTON, FL 34211-4041
(941) 362-8662
(941) 362-8602
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
07/12/2019
Last updated
05/07/2020
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