Individual
MR. JACOB TROY RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
807 S PONDEROSA ST, PAYSON, AZ 85541-5542
(928) 472-1273
Mailing address
823 W SIERRA CIR, PAYSON, AZ 85541-6602
(480) 209-9285
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA1226
AZ
Other
Enumeration date
07/31/2016
Last updated
07/31/2016
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