Individual
DR. JEFFREY LYNN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
RR 1 BOX 34-A, WATONGA, OK 73772-9706
(580) 623-4991
(580) 623-5490
Mailing address
2001 S COUNTRY CLUB RD, APT. #701, EL RENO, OK 73036-5689
(580) 623-4991
(580) 623-5490
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO2966
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9102966
—
OK
Enumeration date
09/22/2006
Last updated
07/09/2007
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