Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 2004035461 | MO |
NPI | 1285656322 |
---|---|
Provider Name | Dr. Russell J Osguthorpe |
First Address | Saint Louis, MO 63156-8221 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 03/08/2010 |