Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 9030 | TN |
NPI | 1972830750 |
---|---|
Provider Name | Dr. Russell D Morrell |
First Address | Memphis, TN 38117-3104 |
Second Address | Memphis, TN 38117-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2009 |
Last Update Date | 01/02/2017 |