Individual
RUSSELL E TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6400 PROSPECT AVE, SUITE440, KANSAS CITY, MO 64132-1100
(816) 361-0277
(916) 361-4733
Mailing address
6400 PROSPECT AVE, SUITE440, KANSAS CITY, MO 64132-1100
(816) 361-0277
(916) 361-4733
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
R6B18
MO
Other
Enumeration date
10/25/2006
Last updated
09/07/2007
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