Individual
EVAN RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2700 CLAY EDWARDS DR STE 240, NORTH KANSAS CITY, MO 64116-3254
(816) 455-0681
(816) 455-5294
Mailing address
2700 CLAY EDWARDS DR STE 240, NORTH KANSAS CITY, MO 64116-3254
(816) 455-0681
(816) 455-5294
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2017013099
MO
207R00000X
Internal Medicine Physician
AP2282058A
OH
208M00000X
Hospitalist Physician
Primary
2017013099
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902211808
—
MO
Enumeration date
06/30/2014
Last updated
07/21/2022
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