JUSTIN LEE RUSSELL PA NPI 1710539416

NPI Information

NPI: 1710539416
Provider Name: JUSTIN LEE RUSSELL, PA
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

Organization: KENNEDY WHITE AND RIGGS ORTHOPEDIC ASSOCIATES

PECOS Registration: Yes

Address:
11505 RANGELAND PKWY
BRADENTON, FL
ZIP 34211
Phone: (941) 362-8662
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Justin Lee Russell, PA is a surgical physician assistant in Bradenton, FL with 5 years of experience. Justin Lee Russell, PA NPI is 1710539416. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

11505 RANGELAND PKWY
BRADENTON, FL
ZIP 34211-041
Phone: (941) 362-8662
Fax: (941) 362-8602

The NPI 1710539416 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/12/2019 and was last updated on 5/7/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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