Deidiker, Russell D

Deidiker, Russell D is an individual health care provider with primary practice located at 1212 Weber Rd Suite 205, Farmington MO 63640-3325. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Deidiker, Russell D can be contacted via phone (573) 756-4581.

Contact Information

Primary practice address
1212 Weber Rd Suite 205 Farmington MO 63640-3325
Phone: (573) 756-4581
Fax: (573) 756-7197
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 113238 Missouri

Profile Details

NPI number 1841265345
LBN Legal business name Deidiker, Russell D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 20th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841265345 NPPES
Missouri MEDICAID 208729707

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