DARIC J RUSSELL

IDAHO FALLS, ID
NPI1154681633
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy207LP2900X Anesthesiology Pain Medicine
(Licence: ID  0-1036)
Enumeration Date2012-05-18
Last Update Date2020-01-06
Business Address
DARIC J RUSSELL DO
3385 POTOMAC WAY
IDAHO FALLS, ID 83404-4978
Phone number: 208-522-7246
Mailing Address
DARIC J RUSSELL DO
3385 POTOMAC WAY
IDAHO FALLS, ID 83404-4978
Phone number: 208-522-7246
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