Organization
RUSSELL DENEA, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL DENEA MD (OWNER)
(904) 471-1300
Entity
Organization
Contact information
Practice address
4102 A1A S, SAINT AUGUSTINE, FL 32080-6942
(904) 471-1300
(904) 471-1333
Mailing address
4102 A1A S, SAINT AUGUSTINE, FL 32080-6942
(904) 471-1300
(904) 471-1333
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
11/08/2017
Last updated
12/27/2017
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