Russell, Kraig M
Russell, Kraig M is an individual health care provider with primary practice located at 10123 Se Market St , Portland OR 97216-2532. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine. Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine is his primary health care specialty. Russell, Kraig M can be contacted via phone (503) 261-6985.Contact Information
Primary practice address
10123 Se Market St
Portland OR 97216-2532
Phone: (503) 261-6985
Fax: (503) 261-6790
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 35087067 | Ohio |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 200900320 | North Carolina |
| Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine | 207RH0002X | 200900320 | North Carolina |
| Allopathic & Osteopathic Physicians / Hospice and Palliative Medicine | 207RH0002X | MD156766 | Oregon |
Profile Details
| NPI number | 1760414916 |
|---|---|
| LBN Legal business name | Russell, Kraig M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 7th, 2006 |
| Last updated | Feb 4th, 2022 - about 4 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 | 1760414916 | NPPES |
| Ohio | MEDICAID | 2663069 | |
| Ohio | MEDICAID | 5911521 |
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