Provider Demographics
NPI:1548261423
Name:ELDRIDGE, RUSSELL M (MD)
Entity type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:M
Last Name:ELDRIDGE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:230 LEXINGTON GREEN CIR
Mailing Address - Street 2:STE 600
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3326
Mailing Address - Country:US
Mailing Address - Phone:859-971-4695
Mailing Address - Fax:859-971-4604
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:#701
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1475
Practice Address - Country:US
Practice Address - Phone:859-276-0414
Practice Address - Fax:859-276-3765
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2017-11-15
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Provider Licenses
StateLicense IDTaxonomies
KY29507207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64295074Medicaid
A99117Medicare UPIN
KYK059840Medicare PIN