Individual
PETER L. RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
830 PRAIRIE CENTER DR, EDEN PRAIRIE, MN 55344-7301
(952) 826-6500
Mailing address
830 PRAIRIE CENTER DR, EDEN PRAIRIE, MN 55344-7301
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20898
MN
Other
Enumeration date
05/16/2006
Last updated
05/12/2008
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