Individual
RYAN RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1019 COMMERCE PKWY, LA GRANGE, KY 40031-8779
(502) 225-9098
(502) 225-9851
Mailing address
127 NORTH ST, BATAVIA, NY 14020-1631
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
TP787
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2019
Last updated
07/08/2022
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