Provider Demographics
NPI:1245208727
Name:PAUL, RUSSELL K (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:K
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9602 STOCKDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3618
Mailing Address - Country:US
Mailing Address - Phone:608-276-5882
Mailing Address - Fax:800-509-9882
Practice Address - Street 1:9602 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3618
Practice Address - Country:US
Practice Address - Phone:608-276-5882
Practice Address - Fax:800-509-9882
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG885192085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34489000Medicaid
007F15875Medicare ID - Type Unspecified
I05816Medicare UPIN