Provider Demographics
NPI:1831276476
Name:RUSSELL, JAMES D (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2318 PAT BOOKER RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3229
Mailing Address - Country:US
Mailing Address - Phone:210-241-2198
Mailing Address - Fax:210-659-7668
Practice Address - Street 1:2318 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-3229
Practice Address - Country:US
Practice Address - Phone:210-659-0323
Practice Address - Fax:210-659-7668
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX000148363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical