Basic Information
| Provider Information | |||||||||
| NPI: | 1265492375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSSELL | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | BULLOCK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1775 ONE HEALING PL | ||||||||
| Address2: | TMH PHYSICIAN PARTNERS, CANCER & HEMATOLOGY | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504315360 | ||||||||
| FaxNumber: | 8504315367 | ||||||||
| Practice Location | |||||||||
| Address1: | 1775 ONE HEALING PL | ||||||||
| Address2: | TMH PHYSICIAN PARTNERS, CANCER & HEMATOLOGY | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323084600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504315360 | ||||||||
| FaxNumber: | 8504315367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101235467 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 0101235467 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | ME122150 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.