Imboden, Russell Todd

Imboden, Russell Todd is an sole proprietor health care provider with primary practice located at 14 Stockell Dr , Eureka MO 63025-1201. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obesity Medicine, which is considered as his primary health care specialty. Imboden, Russell Todd can be contacted via phone (636) 938-7600.

Contact Information

Primary practice address
14 Stockell Dr Eureka MO 63025-1201
Fax: (636) 938-7602
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obesity Medicine 207QB0002X R9H24 Missouri

Profile Details

NPI number 1033372784
LBN Legal business name Imboden, Russell Todd
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 2nd, 2008
Last updated Jul 2nd, 2008 - about 16 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 1033372784 NPPES
Missouri MEDICAID 242531325

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