Provider Demographics
NPI:1396323408
Name:PACE, RUSSELL CLAYTON (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:CLAYTON
Last Name:PACE
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 1:709 N JUSTICE ST STE B
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3455
Mailing Address - Country:US
Mailing Address - Phone:828-696-1234
Mailing Address - Fax:828-696-1257
Practice Address - Street 1:709 N JUSTICE ST STE B
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3455
Practice Address - Country:US
Practice Address - Phone:828-696-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-01686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine