Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 2008034225 | MO |
NPI | 1396300505 |
---|---|
Provider Name | Russell Thurman |
First Address | Rogersville, MO 65742-8737 |
Second Address | Rogersville, MO 65742-8737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2019 |
Last Update Date | 02/05/2019 |