Organization
DOGWOOD EMERGENCY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSS HARRIS (AUTHORIZED SIGNATORY)
(215) 442-5030
Entity
Organization
Contact information
Practice address
801 S ADAMS ST, PETERSBURG, VA 23803-5149
(804) 862-5681
Mailing address
1717 MAIN ST, SUITE 5200, DALLAS, TX 75201-4612
(800) 527-2145
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192296
BLUE SHIELD
VA
Enumeration date
03/30/2007
Last updated
06/23/2008
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