Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 5355 | ND |
NPI | 1013938752 |
---|---|
Provider Name | Howard L Russell |
First Address | Fargo, ND 58122-0001 |
Second Address | Fargo, ND 58122-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 07/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D26256 | (02) | ND |