Provider Demographics
NPI:1700815305
Name:SAWYER, RUSSELL WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:WAYNE
Last Name:SAWYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:707-541-7900
Mailing Address - Fax:707-573-5412
Practice Address - Street 1:246 PERKINS ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6954
Practice Address - Country:US
Practice Address - Phone:707-938-7690
Practice Address - Fax:844-581-1700
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG662272086S0129X, 2086S0129X
CA511294208600000X
TXL66222086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG66227OtherSTATE MEDICAL LICENSE
101036100OtherFIRSTCARE
NM85507539OtherMEDICAID
TX8J0220OtherBLUE CROSS
TX158209001Medicaid
P00010065OtherMEDICARE RAILROAD
TX8J0220OtherBLUE CROSS
101036100OtherFIRSTCARE