Organization
CELLDOX INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS A ROISUM MD (PRESIDENT)
(573) 248-0226
Entity
Organization
Contact information
Practice address
6470 INTERSTATE CT, HANNIBAL, MO 63401-6759
(573) 248-0826
(573) 221-2252
Mailing address
6470 INTERSTATE CT, HANNIBAL, MO 63401-6759
(573) 248-0226
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
00166253
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501875306
—
MO
Enumeration date
08/17/2006
Last updated
05/14/2010
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