Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 94 | AL |
N | 222Z00000X | Podiatrist | 94 | AL |
Y | 213ES0131X | Foot Surgery | 94 | AL |
NPI | 1265420673 |
---|---|
Provider Name | Dr. Robert Irving Russell |
First Address | Birmingham, AL 35205-4700 |
Second Address | Birmingham, AL 35205-4700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 28/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1201219 | UNITED HEALTHCARE (01) | AL |
1265420673 | (02) | AL |
1497957500 | (02) | AL |
1942489232 | (02) | AL |
697685 | UHC GROUP (01) | AL |
T68895 | (02) | AL |