Provider Demographics
NPI:1881646446
Name:SACHS, RUSSELL HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:HOWARD
Last Name:SACHS
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 1:3061 ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9301
Mailing Address - Country:US
Mailing Address - Phone:904-284-7923
Mailing Address - Fax:903-285-1515
Practice Address - Street 1:3052 US HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-9331
Practice Address - Country:US
Practice Address - Phone:904-264-6069
Practice Address - Fax:904-284-1515
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45917207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE34016Medicare UPIN
FL07760Medicare ID - Type Unspecified