Charles Mark Russell PA

NPI 1043218720 - Physician Assistant - 363AM0700X

NPI Details
NPI 1043218720
Gender Male
Enumeration Date 07/07/2005
Last Updated 10/09/2014
Entity Type Individual
Active Over 11 years ago
Practice Location
6157 NW LOOP 410
STE. 124
SAN ANTONIO TX, 78238-3302, US
Phone (210) 523-1411
Fax (210) 523-9307
Business Location
6157 NW LOOP 410
STE. 124
SAN ANTONIO TX, 78238-3302, US
Phone (210) 523-1411
Fax (210) 523-9307
Toxanomy
Taxonomy Code 363AM0700X
License State Texas
License Number PA00353
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According to our database, Charles Mark Russell PA NPI is 1043218720, taxonomy code is 363AM0700X and license number is PA00353, license state is located at Texas. Charles Mark Russell PA physically located at 6157 Nw Loop 410, San Antonio TX, 78238-3302. NPI Number Charles Mark Russell PA has the Individual type.

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1043218720 NPI number is provided on an as is basis without warranty of any kind. 1043218720 is maintained by the National Plan & Provider Enumeration System. The contents of Charles Mark Russell PA are for informational purposes only.