Provider Demographics
NPI:1952864332
Name:RUSSELL, SAMANTHA JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JANE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N CAMPBELL AVE STE 7401
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5040
Mailing Address - Country:US
Mailing Address - Phone:520-626-9660
Mailing Address - Fax:520-626-5801
Practice Address - Street 1:7901 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-8509
Practice Address - Country:US
Practice Address - Phone:520-694-8888
Practice Address - Fax:520-694-8466
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ66096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine