Provider Demographics
NPI:1245387109
Name:RUSSELL, BRAD (MD)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE VANTAGE WAY
Mailing Address - Street 2:ST B240
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228
Mailing Address - Country:US
Mailing Address - Phone:615-329-4020
Mailing Address - Fax:615-329-9479
Practice Address - Street 1:2000 CHURCH STREET
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37236
Practice Address - Country:US
Practice Address - Phone:615-284-8484
Practice Address - Fax:615-284-3854
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN41817207P00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program