Most Relevant Information
Provider Data
| NPI Number: | 1003668542 |
| Provider Name: | KEANNETTE LARRELLE PERKINS RUSSELL MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/05/2024 |
| Last Updated: | 04/05/2024 |
Provider Practice Location
5323 HARRY HINES BLVD
DALLAS
TX
753907201
Practice Location Phone/Fax
| Phone: | 2146483433 |
| Fax: |
Provider Mailing Location
5323 HARRY HINES BLVD
DALLAS
TX
753907201
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |