Individual
JOSEPH MICHAEL JOHN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2830 CRESCENT AVE, EUGENE, OR 97408-7397
(541) 686-9000
(541) 242-4585
Mailing address
PO BOX 1648, EUGENE, OR 97440-1648
(541) 686-9000
(541) 242-4585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500654869
—
OR
Enumeration date
11/30/2012
Last updated
11/12/2015
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