Organization
FORM ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY RUSSELL MD (OWNER)
(617) 505-1520
Entity
Organization
Contact information
Practice address
801 E DOUGLAS AVE FL 2, WICHITA, KS 67202-3548
(617) 505-1520
(617) 928-8401
Mailing address
109 STATE ST., 5TH FL, BOSTON, MA 02109-2906
(617) 505-1520
(617) 928-8401
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Enumeration date
05/19/2023
Last updated
03/18/2026
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