| Russell L. Carlisle, D.o. | |
|
333 Willow Ridge Cv Brandon MS 39047-8089 | |
| (601) 757-5791 | |
| Not Available |
| Full Name | Russell L. Carlisle, D.o. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 333 Willow Ridge Cv, Brandon, Mississippi |
| Authorized Official Name and Position | Russell Carlisle (OWNER) |
| Authorized Official Contact | 6017575791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell L. Carlisle, D.o. 333 Willow Ridge Cv Brandon MS 39047-8089 Ph: (601) 757-5791 | Russell L. Carlisle, D.o. 333 Willow Ridge Cv Brandon MS 39047-8089 Ph: (601) 757-5791 |
| NPI Number | 1528459526 |
|---|---|
| Provider Enumeration Date | 02/11/2015 |
| Last Update Date | 02/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528459526 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 15093 (Mississippi) | Primary |
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