Provider Demographics
NPI:1912355397
Name:RUSSELL W. SAWYER, M.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RUSSELL W. SAWYER, M.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SAWYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-789-6300
Mailing Address - Street 1:141 LYNCH CREEK WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2341
Mailing Address - Country:US
Mailing Address - Phone:707-789-6300
Mailing Address - Fax:707-789-6304
Practice Address - Street 1:141 LYNCH CREEK WAY
Practice Address - Street 2:SUITE A
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2341
Practice Address - Country:US
Practice Address - Phone:707-789-6300
Practice Address - Fax:707-789-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66227208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty