Russell, Charles Mark

Russell, Charles Mark is an individual health care provider with primary practice located at 6157 Nw Loop 410 Ste. 124, San Antonio TX 78238-3302. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Russell, Charles Mark can be contacted via phone (210) 523-1411.

Contact Information

Primary practice address
6157 Nw Loop 410 Ste. 124 San Antonio TX 78238-3302
Phone: (210) 523-1411
Fax: (210) 523-9307
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA00353 Texas

Profile Details

NPI number 1043218720
LBN Legal business name Russell, Charles Mark
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 7th, 2005
Last updated Oct 18th, 2016 - about 9 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 1043218720 NPPES
Texas Other 312676501 WELLMED MEDICAID
Texas Other TXB153718 WELLMED MEDICAID

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