Provider Demographics
NPI:1639327075
Name:RUSSELL, JANET YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:YOUNG
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12014 E WELSH TRL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5108
Mailing Address - Country:US
Mailing Address - Phone:480-451-8150
Mailing Address - Fax:
Practice Address - Street 1:4939 W RAY RD
Practice Address - Street 2:SUITE 28
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2065
Practice Address - Country:US
Practice Address - Phone:480-785-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ25180OtherARIZONA STATE MEDICAL LICENSE