Individual
COLLIN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 S GRAND BLVD, SAINT LOUIS, MO 63104-1016
(314) 977-1928
Mailing address
3691 RUTGER ST RM 137, SAINT LOUIS, MO 63110-2515
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2023025223
MO
Other
Enumeration date
04/11/2018
Last updated
05/28/2024
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