Mayo, Russell Eugene

Mayo, Russell Eugene is an individual health care provider with primary practice located at 300 E 6Th St , Texarkana AR 71854-5207. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Mayo, Russell Eugene can be contacted via phone (870) 779-6000.

Contact Information

Primary practice address
300 E 6Th St Texarkana AR 71854-5207
Phone: (870) 779-6000
Fax: (870) 779-6093
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X C6443 Arkansas
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X G9874 Texas

Profile Details

NPI number 1568469211
LBN Legal business name Mayo, Russell Eugene
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Oct 24th, 2013 - about 11 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 1568469211 NPPES
Texas MEDICAID 137635206
Texas MEDICAID 106188001

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