Provider Demographics
NPI:1861471443
Name:RUSSELL, RICHARD JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2366
Mailing Address - Fax:319-356-2940
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2366
Practice Address - Fax:319-356-2940
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0051868207L00000X
WI2152207L00000X
IAMD-51255207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79550762Medicaid
COP01223541OtherRR MEDICARE
SD0005673OtherWELLMARK NUMBER
SD050059966OtherRAILROAD MEDICARE
SD5700780Medicaid
WY113538400Medicaid
SDS5673Medicare ID - Type UnspecifiedMEDICARE NUMBER
CO310226YTMFMedicare PIN
COP01223541OtherRR MEDICARE
SDS5673Medicare PIN