| Doctor Name: | RUSSELL WADE BRINTNALL |
| NPI Number: | 1609983675 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PA00220 |
| Business Practice Address: | 308 S Cesar Chavez Ave Crystal City, TX - 788394200 |
| Business Phone Number: | 8303742301 |
| Business Fax Number: | 8303749368 |
| Mailing Address: | 308 S Cesar Chavez Ave, CRYSTAL CITY |
| State: | TX |
| Postal Code: | 788394200 |
| Phone Number: | 8303742301 |
| Fax Number: | 8303749368 |
| NPI Enumeration Date: | 08/24/2006 |
| NPI Last Update Date: | 07/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA00220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |