Basic Information
| Provider Information | |||||||||
| NPI: | 1770965899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUSSELL | ||||||||
| FirstName: | REID | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1771 TATE BLVD SE STE 101 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283155110 | ||||||||
| FaxNumber: | 8283153911 | ||||||||
| Practice Location | |||||||||
| Address1: | 1771 TATE BLVD SE STE 101 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283155110 | ||||||||
| FaxNumber: | 8283153911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2015 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 5101021890 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 2021-02373 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.