Broaddus, Russell R.

Broaddus, Russell R. is an individual health care provider with primary practice located at 101 Manning Dr , Chapel Hill NC 27514-4220. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Broaddus, Russell R. can be contacted via phone (919) 966-4676.

Contact Information

Primary practice address
101 Manning Dr Chapel Hill NC 27514-4220
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 2019-02095 North Carolina

Profile Details

NPI number 1891881967
LBN Legal business name Broaddus, Russell R.
Credentials M.D., PH.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 5th, 2006
Last updated Mar 29th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891881967 NPPES
Texas MEDICAID 117205802

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