Provider Demographics
NPI:1780654574
Name:FRANCEK, RUSSELL DOUGLAS (PA-C)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DOUGLAS
Last Name:FRANCEK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HEMLOCK CT
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-4627
Mailing Address - Country:US
Mailing Address - Phone:732-606-2187
Mailing Address - Fax:
Practice Address - Street 1:39 LANSDOWNERD
Practice Address - Street 2:
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733
Practice Address - Country:US
Practice Address - Phone:732-323-7106
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1061804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant