Individual
DR. CHRISTOPHER THOMAS RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
70 DOCTORS PARK, CAPE GIRARDEAU, MO 63703-4928
(573) 334-6071
(573) 334-4739
Mailing address
70 DOCTORS PARK, CAPE GIRARDEAU, MO 63703-4928
(573) 334-6071
(573) 334-4739
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2005014833
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-113584
IL BLUE CROSS BLUE SHIELD
IL
01
—
063896
HEALTH ALLIANCE
—
01
—
185214
MO BLUE CROSS BLUE SHIELD
MO
05
—
207361304
—
MO
01
—
430954380CAP
MERCY HEALTH PLAN
—
01
—
716349
HEALTHLINK
—
Enumeration date
08/01/2006
Last updated
04/29/2021
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