Individual
CORY L RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2570 NW EDENBOWER BLVD., STE 100, ROSEBURG, OR 97471
(541) 957-1111
(541) 229-3335
Mailing address
2570 NW EDENBOWER BLVD., STE 100, ROSEBURG, OR 97471
(541) 957-1111
(541) 229-3335
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO169293
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1102877
—
NV
Enumeration date
04/08/2006
Last updated
06/24/2015
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