Provider Demographics
NPI:1770965899
Name:RUSSELL, REID ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:REID
Middle Name:ROBERT
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1771 TATE BLVD SE STE 101
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4250
Mailing Address - Country:US
Mailing Address - Phone:828-315-5110
Mailing Address - Fax:828-315-3911
Practice Address - Street 1:1771 TATE BLVD SE STE 101
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4250
Practice Address - Country:US
Practice Address - Phone:828-315-5110
Practice Address - Fax:828-315-3911
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101021890207X00000X
NC2021-02373207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery