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:
Health care specialties
| Specialty | Code | License # | 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 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1134115744 | NPPES |
| Missouri | MEDICAID | 208072900 | |
| Missouri | Other | 370013633 |
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