Doctor Name: | MARK R RUSSELL |
NPI Number: | 1053307223 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | MD0000017613 |
Business Practice Address: | 1801 N Jackson St Tullahoma, TN - 373882201 |
Business Phone Number: | 9313933000 |
Business Fax Number: | 9313937806 |
Mailing Address: | 4300 N Access Rd, Suite D CHATTANOOGA |
State: | TN |
Postal Code: | 374153812 |
Phone Number: | 4238261276 |
Fax Number: | 4238261290 |
NPI Enumeration Date: | 09/23/2005 |
NPI Last Update Date: | 08/30/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085R0202X |
License Number: | MD0000017613 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Diagnostic Radiology |
Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |