Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 79209 | MA |
N | 208600000X | Surgeon | 79209 | MA |
N | 2086S0120X | Pediatric Surgery | 79209 | MA |
Y | 2086S0120X | Pediatric Surgery | ME153478 | FL |
NPI | 1215956701 |
---|---|
Provider Name | Dr. Russell W Jennings |
First Address | St Petersburg, FL 33701-4804 |
Second Address | St Petersburg, FL 33701-4804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 27/01/2022 |