Individual
RON C. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1314 19TH AVE, MERIDIAN, MS 39301-4116
(601) 703-4078
(601) 703-4065
Mailing address
PO BOX 5183, MERIDIAN, MS 39302-5183
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
11080
MS
208M00000X
Hospitalist Physician
Primary
11080
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119498
—
MS
05
—
009811080
—
AL
01
—
110167818
RAILROAD MEDICARE
—
01
—
731-02318
BLUE CROSS OF AL
—
Enumeration date
11/17/2005
Last updated
11/09/2013
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