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Individual

DR. THOMAS JEFFREY RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3535 TRAVIS ST STE 170, DALLAS, TX 75204-1480
(214) 522-2661
(214) 522-5469
Mailing address
3535 TRAVIS ST STE 170, DALLAS, TX 75204-1480
(214) 522-2661
(214) 522-5469

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
H2746
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
123810705
TX
01
180041912
RAILROAD MEDICARE
TX
01
8475M0
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/26/2006
Last updated
04/27/2020
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