Russell, Edgar

Russell, Edgar is an individual health care provider with primary practice located at 6276 River Crest Dr , Riverside CA 92507-0754. He recently has only one registered license in Allopathic & Osteopathic Physicians / Adult Medicine, which is considered as his primary health care specialty. Russell, Edgar can be contacted via phone (951) 413-0964.

Contact Information

Primary practice address
6276 River Crest Dr Riverside CA 92507-0754
Phone: (951) 413-0964
Fax: (951) 653-5161
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adult Medicine 207QA0505X 20A6100 California

Profile Details

NPI number 1790707156
LBN Legal business name Russell, Edgar
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 24th, 2006
Last updated Jul 9th, 2007 - about 18 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 1790707156 NPPES
California MEDICAID GR0086790

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