| NPI | 1033373451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID J RUSSELL Owner 541-274-2894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OR MD28531) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: OR MD28531) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2008-10-13 |