Provider Demographics
NPI:1922658897
Name:RUSSELL ROWE, MD, PA
Entity Type:Organization
Organization Name:RUSSELL ROWE, MD, PA
Other - Org Name:REAL SKIN DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-919-0955
Mailing Address - Street 1:5100 FRANKLIN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-6922
Mailing Address - Country:US
Mailing Address - Phone:254-265-7100
Mailing Address - Fax:
Practice Address - Street 1:1507 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-1024
Practice Address - Country:US
Practice Address - Phone:254-265-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty