Individual
SCOTT ANTHONY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3201 S AUSTIN AVE, STE 330, GEORGETOWN, TX 78626-7545
(512) 864-3183
(512) 930-3409
Mailing address
7200 WYOMING SPGS, STE 500, ROUND ROCK, TX 78681-4307
(512) 244-0111
(512) 244-2479
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
H4662
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117275102
—
TX
01
—
4232187
AETNA
TX
Enumeration date
06/23/2005
Last updated
09/29/2010
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