Individual
DR. DANIEL W RUSSELL
Active
Individual
DR. DANIEL W RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANESTHESIOLOGIST
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
Update your record
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