Individual
JEFFREY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10 MEMBERS WAY, SUITE 203, DOVER, NH 03820-5933
(603) 742-3174
(603) 742-1855
Mailing address
789 CENTRAL AVE, DOVER, NH 03820-2526
(603) 742-3174
(603) 742-1855
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7528
NH
207Q00000X
Family Medicine Physician
MD15554
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821037557
—
ME
05
—
3075044
—
NH
Enumeration date
06/06/2006
Last updated
02/17/2014
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