Denea, Russell

Denea, Russell is an sole proprietor health care provider with primary practice located at 4102 A1A S , Saint Augustine FL 32080-6942. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Denea, Russell can be contacted via phone (904) 471-1300.

Contact Information

Primary practice address
4102 A1A S Saint Augustine FL 32080-6942
Phone: (904) 471-1300
Fax: (904) 471-1333
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 195944 New York
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X ME121648 Florida

Profile Details

NPI number 1235175977
LBN Legal business name Denea, Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 21st, 2006
Last updated Mar 17th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235175977 NPPES
New York Other 960396 MVP
New York Other B56MB MVP

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