Cory L Russell, D.O.
Family Medicine in Roseburg, OR. Individual provider (NPI-1).
NPI number1790748028
StatusActive
Last updated in NPPESJun 24, 2015
Details
- NPI
- 1790748028
- Entity type
- Individual (NPI-1)
- Name
- Cory L Russell
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 8, 2006
- Last updated
- Jun 24, 2015
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - FAMILY PRACTICE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | DO169293 | OR | Yes |
Practice location
2570 Nw Edenbower Blvd.Ste 100
Roseburg, OR 97471
Phone 541-957-1111 · Fax 541-229-3335
Mailing address
2570 Nw Edenbower Blvd.Ste 100
Roseburg, OR 97471
Phone 541-957-1111 · Fax 541-229-3335
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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