Provider Demographics
NPI:1982609244
Name:RUSSELL, JAMES CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CRAIG
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:FILE 56765
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-6765
Mailing Address - Country:US
Mailing Address - Phone:602-406-3860
Mailing Address - Fax:602-406-6132
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:STE 400
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4222
Practice Address - Country:US
Practice Address - Phone:602-406-3874
Practice Address - Fax:602-406-4011
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21323174400000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ142042Medicaid
AZ142042Medicaid
AZZ119567Medicare PIN