Provider Demographics
NPI:1760452999
Name:RUSSELL, MELVIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:D
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:TALLASSEE
Mailing Address - State:AL
Mailing Address - Zip Code:36078-1255
Mailing Address - Country:US
Mailing Address - Phone:334-283-3111
Mailing Address - Fax:334-283-3656
Practice Address - Street 1:875 FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:TALLASSEE
Practice Address - State:AL
Practice Address - Zip Code:36078-1255
Practice Address - Country:US
Practice Address - Phone:334-283-3111
Practice Address - Fax:334-283-3656
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00003909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51086222OtherBCBS
AL51086222OtherBCBS