Individual
GEORGE R RUSSELL
Active
Individual
GEORGE R RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
17600
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01176007
—
CO
01
—
4009828
AETNA
CO
01
—
667695
BCBS FEDERAL
CO
01
—
840721166001
ROCKY MOUNTAIN
CO
01
—
84072116601
PACIFICARE
CO
01
—
RU78831
BLUE CROSS
CO
Enumeration date
03/17/2006
Last updated
07/25/2008
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