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Individual

JOHN RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
22 HARTFORD ST # SR, HOULTON, ME 04730-1844
(207) 532-4068
Mailing address
1519 3RD ST SE STE 210, PUYALLUP, WA 98372-3742

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
MD00027077
WA
208800000X
Urology Physician
Primary
MD20256
ME

Other

Enumeration date
07/12/2006
Last updated
05/16/2017
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