Organization
ELDORADO OBSTETRICS AND GYNECOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAMILLE ALETHA RUSSELL MCKESEY (OBGYN OWNER)
(316) 320-0501
Entity
Organization
Contact information
Practice address
700 WEST CENTRAL, SUITE 412, EL DORADO, KS 67042
(316) 320-0501
(316) 321-0503
Mailing address
700 WEST CENTRAL, SUITE 412, EL DORADO, KS 67042
(316) 320-0501
(316) 321-0503
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0430298
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100642490A
—
KS
01
—
103157
BCBS OF KS
KS
01
—
453460
FIBTGUARD
KS
Enumeration date
10/19/2006
Last updated
08/25/2008
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