Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD-48564 | IA |
N | 207W00000X | Ophthalmologist | ME139298 | FL |
N | 207WX0107X | Retina Specialist | MD-48564 | IA |
NPI | 1013301910 |
---|---|
Provider Name | Dr. Jonathan Foster Russell |
First Address | Iowa City, IA 52242-1009 |
Second Address | Iowa City, IA 52242-1009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 16/09/2021 |