Individual
DR. JOHN R. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
608 S HIGHWAY 65 82, LAKE VILLAGE, AR 71653-1743
(870) 265-9810
(870) 265-9813
Mailing address
2918 LOUIS SESSIONS STREET, LAKE VILLAGE, AR 71653
(870) 265-5343
(870) 265-5686
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C4971
AR
208M00000X
Hospitalist Physician
Primary
C4971
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101410001
—
AR
Enumeration date
01/11/2006
Last updated
10/01/2024
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