Individual
DR. RUSSELL VAN HUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
M6927
TX
2086S0127X
Trauma Surgery Physician
M6927
TX
2086S0129X
Vascular Surgery Physician
Primary
M6927
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81521235
—
NM
01
—
8J0221
BLUE CROSS BLUE SHIELD
TX
01
—
8J7359
MEDICARE PROVIDER NUMBER
TX
Enumeration date
06/11/2007
Last updated
04/15/2015
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