Provider Demographics
NPI:1871587774
Name:HIRST, RUSSELL NELSON JR (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:NELSON
Last Name:HIRST
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1565 S 800 E
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:UT
Mailing Address - Zip Code:84320-2023
Mailing Address - Country:US
Mailing Address - Phone:435-258-2441
Mailing Address - Fax:435-258-5266
Practice Address - Street 1:1565 S 800 E
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:UT
Practice Address - Zip Code:84320-2023
Practice Address - Country:US
Practice Address - Phone:435-258-2441
Practice Address - Fax:435-258-5266
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT71-1522551205207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD99465Medicare UPIN