Provider Demographics
NPI:1306869185
Name:RUSS, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:RUSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 AIRPARK DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2462
Mailing Address - Country:US
Mailing Address - Phone:530-241-7300
Mailing Address - Fax:530-241-9783
Practice Address - Street 1:2510 AIRPARK DR
Practice Address - Street 2:SUITE 302
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2462
Practice Address - Country:US
Practice Address - Phone:530-241-7300
Practice Address - Fax:530-241-9783
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34080207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A340800Medicaid
CAA27362Medicare UPIN
CA00A340800Medicare ID - Type Unspecified