| Doctor Name: | RUSSELL B PINCOCK |
| NPI Number: | 1356636443 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP-C |
| License Number: | 49201274405 |
| Business Practice Address: | 802 S 200 W Blanding, UT - 845113910 |
| Business Phone Number: | 4356513291 |
| Business Fax Number: | 4356513376 |
| Mailing Address: | Po Box 130, MONTEZUMA CREEK |
| State: | UT |
| Postal Code: | 845340130 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/16/2011 |
| NPI Last Update Date: | 06/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 49201274405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |