Provider Demographics
NPI:1992817480
Name:EARNEST, RUSSELL DAVID JR (DPM)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:DAVID
Last Name:EARNEST
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 ALVERSER PLZ
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2604
Mailing Address - Country:US
Mailing Address - Phone:804-594-1944
Mailing Address - Fax:804-594-1945
Practice Address - Street 1:1336 ALVERSER PLZ
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2604
Practice Address - Country:US
Practice Address - Phone:804-594-1944
Practice Address - Fax:804-594-1945
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300896213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010049351Medicaid
VA389911OtherANTHEM
VA861077371OtherPHCS
VA2126938OtherMAMSI
VA3106155OtherCIGNA
VA605671100OtherOWCP
VA7797532OtherAETNA
VA2139749OtherFIRST HEALTH
VA232349OtherSOUTHERN HEALTH
VA010049351Medicaid
VA605671100OtherOWCP
VA2126938OtherMAMSI
VA861077371OtherPHCS
VA3106155OtherCIGNA