Provider Demographics
NPI:1437138005
Name:TOPHAM, RUSSELL TODD (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:TODD
Last Name:TOPHAM
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 1:3309 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701
Mailing Address - Country:US
Mailing Address - Phone:903-565-0303
Mailing Address - Fax:903-565-5446
Practice Address - Street 1:3309 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-565-0303
Practice Address - Fax:903-565-5446
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G04218Medicare UPIN
8C8105Medicare ID - Type Unspecified