Provider Demographics
NPI:1659064244
Name:COLMORE, RUSSELL III
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:
Last Name:COLMORE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 ALBION PL N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-8875
Mailing Address - Country:US
Mailing Address - Phone:206-429-1898
Mailing Address - Fax:
Practice Address - Street 1:3512 ALBION PL N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8875
Practice Address - Country:US
Practice Address - Phone:206-429-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist