Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 53049-20 | WI |
Y | 2081P2900X | Pain Medicine | DR.0051431 | CO |
NPI | 1346430030 |
---|---|
Provider Name | Dr. Patrick Winston Russell |
First Address | Denver, CO 80247-1314 |
Second Address | Denver, CO 80205-5437 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2007 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022880 | KAISER COMMERCIAL NUMBER (01) | CO |
24138711 | (05) | CO |