Individual
MARK S RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3633 CENTRAL AVENUE, SUITE D, HOT SPRINGS, AR 71913-6475
(501) 623-6693
(501) 623-9403
Mailing address
3633 CENTRAL AVENUE, SUITE D, HOT SPRINGS, AR 71913-6475
(501) 623-6693
(501) 623-9403
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
C6875
AR
2085R0202X
Diagnostic Radiology Physician
Primary
C-6875
AR
2085R0204X
Vascular & Interventional Radiology Physician
C-6875
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110923001
—
AR
01
—
546256799
MEDICARE GROUP PIN
AR
01
—
C6875
STATE LICENSE
AR
Enumeration date
10/26/2005
Last updated
03/07/2023
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