Individual
RUSSELL E EGGEBRECHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8888 LADUE RD, STE 210, SAINT LOUIS, MO 63124-2056
(314) 862-5044
(314) 862-2734
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(314) 862-5044
(314) 862-2734
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R5480
MO
207RC0000X
Cardiovascular Disease Physician
Primary
R5480
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110056201
RR MEDICARE
MO
05
—
202631628
—
MO
Enumeration date
07/18/2006
Last updated
11/11/2015
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