Organization
MINERAL AREA LABORATORIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL DEIDIKER MD (PROVIDER)
(888) 275-9737
Entity
Organization
Contact information
Practice address
1212 WEBER RD, FARMINGTON, MO 63640-3325
(573) 756-4581
(573) 756-7197
Mailing address
PO BOX 78159, SAINT LOUIS, MO 63178-8159
(800) 354-1088
(314) 845-5668
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
12/04/2008
Last updated
12/04/2008
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