Individual
TIFFANY LEE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
697 LOUISIANA RD, DYESS AFB, TX 79607-1141
(325) 696-6600
Mailing address
697 LOUISIANA RD, DYESS AFB, TX 79607-1141
(325) 696-6600
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
T2968
TX
Other
Enumeration date
03/30/2020
Last updated
09/14/2021
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