Provider Demographics
NPI:1194019158
Name:RUSSELL, MARY ELIZABETH (DO, MS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:RUSSELL
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Gender:F
Credentials:DO, MS
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Mailing Address - Street 1:9250 PINECROFT DR.
Mailing Address - Street 2:TIRR
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:713-897-4909
Mailing Address - Fax:713-897-4919
Practice Address - Street 1:9250 PINECROFT DRIVE
Practice Address - Street 2:TIRR
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3256
Practice Address - Country:US
Practice Address - Phone:713-897-4909
Practice Address - Fax:713-897-4919
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2023-12-21
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Provider Licenses
StateLicense IDTaxonomies
TXQ0354208100000X
IADO-04572208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8HS092OtherBCBS
TX378844001Medicaid
623197YKY3OtherMEDICARE