Provider Demographics
NPI:1215936232
Name:MAIER, RUSSELL G (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:G
Last Name:MAIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:940 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-942-2516
Practice Address - Fax:509-942-2527
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0043866OtherLABOR & INDUSTRIES
WA8139974Medicaid
WAP00050802OtherMEDICARE RAILROAD
WA8921992OtherCRIME VICTIM
WAAB38069Medicare PIN
WA0043866OtherLABOR & INDUSTRIES