Individual
RUSSELL R. BROADDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
101 MANNING DR, CHAPEL HILL, NC 27514-4220
(919) 966-4676
Mailing address
160 NORTH MEDICAL DR, CAMPUS BOX 7525, CHAPEL HILL, NC 27599-5022
(919) 966-4676
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2019-02095
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117205802
—
TX
Enumeration date
10/05/2006
Last updated
03/29/2021
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