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1801030564
TRAVIS CHARLES RUSSELL
APO, AP
NPI
1801030564
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: NE 26003)
Enumeration Date
2009-04-25
Last Update Date
2021-06-10
Business Address
Dr. TRAVIS CHARLES RUSSELL M.D.
18 MDG, UNIT 5142
APO, AP 96368
Phone number: 315-630-4229
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Mailing Address
Dr. TRAVIS CHARLES RUSSELL M.D.
PSC 80 BOX 16805
APO, AP 96367-0071
Phone number: 801-678-1416
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