Provider Demographics
NPI:1700861283
Name:RUSSELL, RHONDA A (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:A
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9202 ELAM RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-4151
Practice Address - Country:US
Practice Address - Phone:214-266-1671
Practice Address - Fax:214-266-1829
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ77822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124507815Medicaid
TX124507818Medicaid
TX124507807Medicaid
TX124507809Medicaid
TX124507823Medicaid
TX260051188OtherRAILROAD MEDICARE
TX124507812Medicaid
TX124507819Medicaid
TX124507813Medicaid
TX124507811Medicaid
TX124507821Medicaid
TX124507817Medicaid
TX8080N3OtherBLUE CROSS BLUE SHIELD
TX124507809Medicaid
TX8080N3Medicare PIN