Individual
DEBRA KAYE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1001 TOWSON AVE, FORT SMITH, AR 72901-4921
(479) 441-4000
Mailing address
PO BOX 1983, FORT SMITH, AR 72902-1983
(479) 452-9416
(479) 484-0827
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
20630
OK
2085R0202X
Diagnostic Radiology Physician
Primary
E1315
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100077300A
—
OK
05
—
134580001
—
AR
Enumeration date
01/23/2006
Last updated
04/30/2019
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