Provider Demographics
NPI:1821450602
Name:RUSS, JEFFREY BRIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:RUSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 16TH ST FL 4
Mailing Address - Street 2:4551, BOX 0110
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2549
Mailing Address - Country:US
Mailing Address - Phone:303-912-7799
Mailing Address - Fax:
Practice Address - Street 1:550 16TH ST FL 4
Practice Address - Street 2:4551, BOX 0110
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2549
Practice Address - Country:US
Practice Address - Phone:303-912-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program