Phillip G Russell, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

12288 Issued in OK

Practice address

4721 W 6TH Ave Ste 130
Stillwater, OK 74074-1549

Phone

(405) 743-0550

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598313600000",
    "number": "1659353480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4721 W 6TH AVE STE 130",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740741549",
            "telephone_number": "405-743-0550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 W 6TH AVE STE 130",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740741549",
            "telephone_number": "405-743-0550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "PHILLIP",
        "middle_name": "G",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "OK",
            "license": "12288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Rovick
• Lacy Anne Ruby, M.S.
• Darrin Lashae Rupp
• Walter Mieczyslaw Rusin, MEDICAL STUDENT
• Russell C. Brorsen, D.D.S., P.L.L.C. (Brorsen Family Dental)
• Kelly Ruth Sabers, ATC
• Darrell Lynn Sadler, DDS
• Sager Healthcare, PLLC
• Leslie Morgan Sala
• Kristen Sample

• Diagnostic Radiology Physician in Stillwater, OK
• Providers in Stillwater, OK by specialty
• Diagnostic Radiology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.