Provider Demographics
NPI:1902885395
Name:RUSSELL, THOMAS K (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:6606 LBJ FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4650207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126445911Medicaid
TX126445907Medicaid
TX126445906Medicaid
TX126445910Medicaid
TX8EY200OtherBCBS
TX126445908Medicaid
TX8B8948Medicare ID - Type UnspecifiedDALLAS
TX126445911Medicaid
TX8EY200OtherBCBS
TX8B8621Medicare ID - Type UnspecifiedTARRANT
TX126445907Medicaid
C21427Medicare UPIN