Provider Demographics
NPI:1912260886
Name:RUSSELL, LLOYD W (MD)
Entity Type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:W
Last Name:RUSSELL
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 1:7325 SIBLEY ST
Mailing Address - Street 2:PO BOX 1040
Mailing Address - City:MONTROSE
Mailing Address - State:AL
Mailing Address - Zip Code:36559-2100
Mailing Address - Country:US
Mailing Address - Phone:251-401-3428
Mailing Address - Fax:
Practice Address - Street 1:7325 SIBLEY ST
Practice Address - Street 2:1040
Practice Address - City:MONTROSE
Practice Address - State:AL
Practice Address - Zip Code:36559-2100
Practice Address - Country:US
Practice Address - Phone:251-401-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2303207QA0505X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine