Organization
JONATHAN R RUSSELL, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN R RUSSELL M.D. (PRESIDENT/PHYSICIAN)
(281) 440-4089
Entity
Organization
Contact information
Practice address
10130 LOUETTA RD, STE G, HOUSTON, TX 77070-2118
(281) 440-4089
(832) 559-3718
Mailing address
503 COLUMBIA ST, HOUSTON, TX 77007-2625
(832) 746-4301
(832) 559-3718
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L0557
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
143751902
—
TX
Enumeration date
08/17/2009
Last updated
11/16/2011
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