Individual
DR. KIRK SHANE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
WOMACK ARMY MEDICAL CENTER 2817 ROCK MERRITT AVE, FORT LIBERTY, NC 28310-6644
(910) 907-8707
(910) 907-8707
Mailing address
WOMACK ARMY MEDICAL CENTER 2817 ROCK MERRITT AVE, FORT LIBERTY, NC 28310-0001
(910) 907-8707
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
2014-02064
NC
2085R0202X
Diagnostic Radiology Physician
230324
NY
2085R0204X
Vascular & Interventional Radiology Physician
Primary
2014-02064
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912075631
—
NC
Enumeration date
12/01/2006
Last updated
01/31/2025
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