Basic Information
| Provider Information | |||||||||
| NPI: | 1427337914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUSSELL | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | NAVAL MEDICAL CENTER SAN DIEGO | ||||||||
| Address2: | 34800 BOB WILSON DRIVE | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921340001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195327504 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NAVAL MEDICAL CENTER SAN DIEGO | ||||||||
| Address2: | 34800 BOB WILSON DRIVE | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921340001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195327504 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2011 | ||||||||
| LastUpdateDate: | 02/14/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 123886 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.