Provider Demographics
NPI:1932212917
Name:ENGLAND, RUSSELL DUANE (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DUANE
Last Name:ENGLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 W LOWE AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2470
Mailing Address - Country:US
Mailing Address - Phone:641-472-7216
Mailing Address - Fax:641-209-6690
Practice Address - Street 1:200 W LOWE AVE STE 206
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2470
Practice Address - Country:US
Practice Address - Phone:641-472-7216
Practice Address - Fax:641-209-6690
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA231262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0056978Medicaid
IA0056978Medicaid
IAA03854Medicare UPIN
IAA03854Medicare UPIN