| Doctor Name: | JAMES D RUSSELL |
| NPI Number: | 1831276476 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 000148 |
| Business Practice Address: | 2318 Pat Booker Rd Universal City, TX - 781483229 |
| Business Phone Number: | 2106590323 |
| Business Fax Number: | 2106597668 |
| Mailing Address: | 2318 Pat Booker Rd, UNIVERSAL CITY |
| State: | TX |
| Postal Code: | 781483229 |
| Phone Number: | 2102412198 |
| Fax Number: | 2106597668 |
| NPI Enumeration Date: | 11/01/2006 |
| NPI Last Update Date: | 01/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 000148 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |