Individual
KENNETH J RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
SEATTLE CANCER CARE ALLIANCE, 825 EASTLAKE AVENUE EAST, SEATTLE, WA 98109
(206) 288-1012
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
MD00023196
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009968
—
WA
01
—
7017
INTERNAL ID-MOTOR VEHICLE ID
—
Enumeration date
10/27/2006
Last updated
07/08/2007
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