Provider Demographics
NPI:1225072945
Name:RUSSELL J. KEIZER MD PC
Entity Type:Organization
Organization Name:RUSSELL J. KEIZER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-325-2448
Mailing Address - Street 1:2120 EXCHANGE ST #203
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103
Mailing Address - Country:US
Mailing Address - Phone:503-325-2448
Mailing Address - Fax:503-325-2487
Practice Address - Street 1:2120 EXCHANGE ST #203
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103
Practice Address - Country:US
Practice Address - Phone:503-325-2448
Practice Address - Fax:503-325-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08049261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center