Individual
JEFFREY D. RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AUD
Contact information
Practice address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28547-2538
(910) 450-4159
(910) 450-4194
Mailing address
100 BREWSTER BLVD, NAVAL HOSPITAL, CAMP LEJEUNE, NC 28547-2538
(910) 450-4159
(910) 450-4194
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AY 941
FL
231HA2400X
Assistive Technology Practitioner Audiologist
AY941
FL
237600000X
Audiologist-Hearing Aid Fitter
AY941
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S2985
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/22/2006
Last updated
06/10/2025
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