Russell, Cory L
Russell, Cory L is an individual health care provider with primary practice located at 2570 Nw Edenbower Blvd. Ste 100, Roseburg OR 97471. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Russell, Cory L can be contacted via phone (541) 957-1111.Contact Information
Primary practice address
2570 Nw Edenbower Blvd. Ste 100
Roseburg OR 97471
Phone: (541) 957-1111
Fax: (541) 229-3335
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | DO169293 | Oregon |
Profile Details
| NPI number | 1790748028 |
|---|---|
| LBN Legal business name | Russell, Cory L |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 8th, 2006 |
| Last updated | Jun 24th, 2015 - about 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1790748028 | NPPES |
| Nevada | MEDICAID | 1102877 |
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