Provider Demographics
NPI:1871552687
Name:BILES, RUSSEL KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:KEVIN
Last Name:BILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RUSSEL
Other - Middle Name:K
Other - Last Name:BILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:748 N EARL RUDDER FWY
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2914
Practice Address - Country:US
Practice Address - Phone:979-207-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84M132OtherBLUE SHIELD
TX080162709OtherRR/MEDICARE
TX1176620-03Medicaid
TX080162709OtherRR/MEDICARE
TX1176620-03Medicaid