Provider Demographics
NPI:1447280300
Name:RUSSELL, BRUCE WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:WAYNE
Last Name:RUSSELL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:SUMITON
Mailing Address - State:AL
Mailing Address - Zip Code:35148-0159
Mailing Address - Country:US
Mailing Address - Phone:205-648-6637
Mailing Address - Fax:205-648-5186
Practice Address - Street 1:385 BRYAN RD STE 100
Practice Address - Street 2:COMMUNITY PROFESSIONAL BUILDING
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-3422
Practice Address - Country:US
Practice Address - Phone:205-648-6637
Practice Address - Fax:205-648-5186
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-07-07
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Provider Licenses
StateLicense IDTaxonomies
AL4253208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC70371Medicare UPIN