Provider Demographics
NPI:1336336205
Name:HUQ, RUSSELL MAHMUDUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:MAHMUDUL
Last Name:HUQ
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 1:440 HOPKINSVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42345-1124
Mailing Address - Country:US
Mailing Address - Phone:270-338-8000
Mailing Address - Fax:270-338-8000
Practice Address - Street 1:800 W AIRPORT FWY STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-6206
Practice Address - Country:US
Practice Address - Phone:214-952-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK29905207P00000X, 207Q00000X
KY45542207P00000X, 207Q00000X
MO2009026103207Q00000X
TXBP10030099207Q00000X
TXS3534207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01205237OtherMEDICARE RAILROAD
MO1447412770OtherRH MEDICAID
KY7100215160Medicaid
KY7100215160Medicaid
KYK052192Medicare PIN