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GERALD LEE RUSSELL PHD

Clinical Neuropsychologist

Las Vegas, New Mexico

Provider NPI: 1326040148

Provider Information:
 GERALD LEE RUSSELL PHD
Gender: M


Practice Location:
713 6TH ST  LAS VEGAS, NM 87701 US
Tel: 505-429-4679  Fax: 505-425-3370

Business Mailing Address:
PO BOX 1705  LAS VEGAS, NM 87701 US
Tel: 505-454-2202  Fax: 505-454-2211

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
NM761

Other Provider Identifiers:

IssuerNumberStateType
76705NM05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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