Individual
DR. KEVIN L. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MTM&H
Contact information
Practice address
34800 BOB WILSON DR, NMCSD, SAN DIEGO, CA 92134-1098
(760) 522-8973
Mailing address
1615 E 7TH ST, OKMULGEE, OK 74447-4813
(760) 522-8973
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
20269
AZ
Other
Enumeration date
02/02/2007
Last updated
07/08/2007
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