Provider Demographics
NPI:1497493290
Name:GREGORY, RUSSELL NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:NEAL
Last Name:GREGORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:404 S BRADLEY ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:AR
Mailing Address - Zip Code:71671-3459
Mailing Address - Country:US
Mailing Address - Phone:870-226-8636
Mailing Address - Fax:870-226-8655
Practice Address - Street 1:404 S BRADLEY ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-3459
Practice Address - Country:US
Practice Address - Phone:870-226-8636
Practice Address - Fax:870-226-8655
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2025-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-18848207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine