Provider Demographics
NPI:1790798981
Name:RUSSIN, DARIUS GILES (MD)
Entity Type:Individual
Prefix:DR
First Name:DARIUS
Middle Name:GILES
Last Name:RUSSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 RED RIVER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1832
Mailing Address - Country:US
Mailing Address - Phone:254-297-3322
Mailing Address - Fax:254-297-3411
Practice Address - Street 1:VA HEALTH CARE SYSTEM
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501
Practice Address - Country:US
Practice Address - Phone:254-297-3322
Practice Address - Fax:254-297-3411
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine