Individual
JEFFREY KIRK RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
907 GEORGIANA ST, PORT ANGELES, WA 98362-3911
(360) 565-0999
(360) 565-9251
Mailing address
PO BOX 850, PORT ANGELES, WA 98362-0146
(360) 417-7111
(360) 417-7342
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60898671
WA
Other
Enumeration date
12/07/2005
Last updated
03/11/2020
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