Provider Demographics
NPI:1528049939
Name:RUSSELL, JOHN R (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:RUSSELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5 MOBILE INFIRMARY CR.
Mailing Address - Street 2:STE. G-805
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3513
Mailing Address - Country:US
Mailing Address - Phone:251-435-2273
Mailing Address - Fax:251-435-6599
Practice Address - Street 1:5 MOBILE INFIRMARY CR. STE. G-805
Practice Address - Street 2:MOBILE INFIRMARY RADIATION ONCOLOGY
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-435-2273
Practice Address - Fax:251-435-6599
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2016-12-30
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Provider Licenses
StateLicense IDTaxonomies
AL111092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000012148Medicaid
C76275Medicare UPIN
AL000012148Medicaid