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Contact Information

DARIC J RUSSELL, DO
3385 POTOMAC WAY
IDAHO FALLS, ID83404-4978
 Phone: 208-522-7246
 Fax: 208-529-2620
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

207LP2900X 05 Physician/Anesthesiology
Indicates primary specialty

NPI Profile & details for DARIC J RUSSELL · (Male)

NPI Number 1154681633
Status Active
Credentials DO (Doctor of Osteopathic)
Entity Individual
Enumeration date 05/18/2012
Last updated 01/06/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • ID License # 0-1036
Hospital affiliation(s)
  • MADISON MEMORIAL HOSPITAL - (Acute Care)
    255 N 3RD E
    REXBURG, ID 83440
  • MOUNTAIN VIEW HOSPITAL - (Acute Care)
    2325 CORONADO STREET
    IDAHO FALLS, ID 83404
  • TETON VALLEY HOSPITAL - (Critical Access)
    252 SOUTH MAIN STREET
    VICTOR, ID 83455
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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