Russell, John J
Russell, John J is an sole proprietor health care provider with primary practice located at 1610 N Kings Highway St Suite 304, Cape Girardeau MO 63701-2196. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Russell, John J can be contacted via phone (573) 335-2191.Contact Information
Primary practice address
1610 N Kings Highway St Suite 304
Cape Girardeau MO 63701-2196
Phone: (573) 335-2191
Fax: (573) 335-5524
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 100521 | Missouri |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 100521 | Missouri |
Profile Details
| NPI number | 1124098728 |
|---|---|
| LBN Legal business name | Russell, John J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 25th, 2006 |
| Last updated | Jan 21st, 2015 - about 9 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124098728 | NPPES |
| Missouri | Other | 178739 | HEALTHLINK |
| Missouri | Other | 125591 | HEALTHLINK |
| Missouri | MEDICAID | 203340815 | HEALTHLINK |
| Missouri | Other | 370018381 | HEALTHLINK |
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