Russell, Trent K

Russell, Trent K is an individual health care provider with primary practice located at 1057 Medical Park Dr Suite A, Osage Beach MO 65065-3050. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Russell, Trent K can be contacted via phone (573) 348-2745.

Contact Information

Primary practice address
1057 Medical Park Dr Suite A Osage Beach MO 65065-3050
Phone: (573) 348-2745
Fax: (573) 348-8279
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 107627 Missouri

Profile Details

NPI number 1134115744
LBN Legal business name Russell, Trent K
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2005
Last updated May 5th, 2008 - about 18 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 1134115744 NPPES
Missouri MEDICAID 208072900
Missouri Other 370013633

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