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Individual

WILLIAM M RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
5317 ATLANTIC AVE STE 104, DELRAY BEACH, FL 33484-8175
(561) 496-6000
Mailing address
5700 LAKE WORTH RD STE 204, GREENACRES, FL 33463-3213
(561) 966-7707

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
D30182
MD
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
D0030182
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0012
BCBS OF DC
01
0943ER-399490-05
CAREFIRST BCBS OF MD
05
369001600
MD
01
39949003
BCBS OF MD
Enumeration date
10/13/2006
Last updated
12/13/2021
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