Individual
DR. RUSSELL D DEIDIKER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1212 WEBER RD, SUITE 205, FARMINGTON, MO 63640-3325
(573) 756-4581
(573) 756-7197
Mailing address
312 LOUISE ST, FARMINGTON, MO 63640-2706
(573) 756-4581
(573) 756-7197
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
113238
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208729707
—
MO
Enumeration date
02/20/2006
Last updated
07/08/2007
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