Russell W Brown, D.O.
Individual provider Active NPI Family Medicine Physician · Herrin, IL
NPI 1891809810 · NPPES record last updated Nov 3, 2011
Key facts
- NPI
- 1891809810
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036081556 (IL)
- Practice address
- 405 Rushing Dr
Herrin, IL 62948-3730 - Phone
- (618) 993-3300
- Fax
- (618) 997-6626
- NPI assigned
- Aug 18, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036081556 | IL | Yes |
Addresses
Primary practice location
405 Rushing Dr
Herrin, IL 62948-3730
Mailing address
PO Box 1105
Indianapolis, IN 46206-1105
Phone (618) 549-5361
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 043448 | Other | HEALTH ALLIANCE | |
| 036081556 | Medicaid | IL | |
| 080129117 | Other | BCBS | |
| 174143 | Other | HEALTH LINK | |
| 10019630 | Other | RAILROAD MEDICARE |
Other providers in Herrin, IL
- Amanda Laine Brazis
- Robert Judson Brewer
- Daniel R Brown
- Jennifer E Brown
- Patrick David Brown
- Treg D Brown
- Jesse Paul Bueza
- Sarah Burdick
- Elizabeth Ann Bush
- Austin Thomas Butler
All providers in Herrin, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.