Individual
KRAIG M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10123 SE MARKET ST, PORTLAND, OR 97216-2532
(503) 261-6985
(503) 261-6790
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
(503) 261-6985
(503) 261-6790
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200900320
NC
207R00000X
Internal Medicine Physician
35087067
OH
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
200900320
NC
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
MD156766
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2663069
—
OH
05
—
5911521
—
NC
Enumeration date
07/07/2006
Last updated
02/04/2022
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