Individual
DR. RUSSELL KL WON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6500 LANSDOWNE AVE, SAINT LOUIS, MO 63109-2654
(314) 352-7003
Mailing address
6500 LANSDOWNE AVE, SAINT LOUIS, MO 63109-2654
(314) 352-7003
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
R6B25
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201567013
—
MO
Enumeration date
10/06/2006
Last updated
07/08/2007
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