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Individual

DR. JOHN J RUSSELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1610 N KINGS HIGHWAY ST, SUITE 304, CAPE GIRARDEAU, MO 63701-2196
(573) 335-2191
(573) 335-5524
Mailing address
1610 N KINGS HIGHWAY ST, SUITE 304, CAPE GIRARDEAU, MO 63701-2196
(573) 335-2191
(573) 335-5524

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
100521
MO
208000000X
Pediatrics Physician
Primary
100521
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
125591
BLUE CROSS BLUE SHIELD
MO
01
178739
HEALTHLINK
MO
05
203340815
MO
01
370018381
RAILROAD MEDICARE
MO
Enumeration date
01/25/2006
Last updated
01/21/2015
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