Individual
MR. DENVER ALAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
269 PORTLAND WAY S, GALION, OH 44833-2312
(419) 468-4841
Mailing address
700 N COLUMBUS ST, CRESTLINE, OH 44827-1455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.004618RX
OH
Other
Enumeration date
11/18/2015
Last updated
01/11/2021
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