Individual
DR. RUSSELL TODD IMBODEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
14 STOCKELL DR, EUREKA, MO 63025-1201
(636) 938-7600
(636) 938-7602
Mailing address
14 STOCKELL DR, EUREKA, MO 63025-1201
(636) 938-7600
(636) 938-7602
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
R9H24
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
242531325
—
MO
Enumeration date
07/02/2008
Last updated
07/02/2008
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