Individual
DR. DANIEL W RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANESTHESIOLOGIST
Contact information
Practice address
2900 1ST AVE, HUNTINGTON, WV 25702-1241
(304) 526-1031
Mailing address
PO BOX 515, BARBOURSVILLE, WV 25504-0515
(304) 736-6126
(304) 736-1531
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
17669
WV
207L00000X
Anesthesiology Physician
35.062056
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001720692
WV BLUE CROSS PROVIDER #
WV
05
—
0060658000
—
WV
01
—
550696369-00
W.V. WORKERS PROVIDER #
WV
Enumeration date
11/14/2006
Last updated
09/22/2011
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