Provider Demographics
NPI:1790734366
Name:FOULK, RUSSELL ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:ALLEN
Last Name:FOULK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:645 SIERRA ROSE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2060
Mailing Address - Country:US
Mailing Address - Phone:775-828-1200
Mailing Address - Fax:775-828-1785
Practice Address - Street 1:645 SIERRA ROSE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2060
Practice Address - Country:US
Practice Address - Phone:775-828-1200
Practice Address - Fax:775-828-1785
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2019-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM-7577207VE0102X
NV7698207VE0102X
CAG72373207VE0102X
UT6333431-1205207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology