Individual
GEORGE R RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 ALPINE AVE, #50, BOULDER, CO 80304-3409
(303) 444-4864
(303) 444-4865
Mailing address
PO BOX 18058, BOULDER, CO 80308-1058
(303) 444-4864
(303) 444-4865
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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