Provider Demographics
NPI:1265420673
Name:RUSSELL, ROBERT IRVING (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:IRVING
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4700
Mailing Address - Country:US
Mailing Address - Phone:205-933-9595
Mailing Address - Fax:205-933-5250
Practice Address - Street 1:1717 11TH AVE SOUTH
Practice Address - Street 2:SUITE 402
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4700
Practice Address - Country:US
Practice Address - Phone:205-933-9595
Practice Address - Fax:205-933-5250
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL94213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1201219OtherUNITED HEALTHCARE
AL697685OtherUHC GROUP
AL630708798OtherEIN
AL0286530005Medicare NSC
AL480014276Medicare PIN
ALT68895Medicare UPIN
ALD447Medicare PIN
AL000070985Medicare PIN
AL000072719Medicare PIN
AL1497957500Medicare UPIN
AL697685OtherUHC GROUP
AL630708798OtherEIN
AL0286530001Medicare NSC