Individual
DEBORA J RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
516 E. NIZHONI BLVD, BOX 1337, GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1294
Mailing address
516 E. NIZHONI BLVD, BOX 1337, GALLUP, NM 87301-1337
(505) 722-1000
(505) 722-1294
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
99-292
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00073104
—
NM
05
—
489626
—
AZ
Enumeration date
07/11/2006
Last updated
04/17/2008
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