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General NPI Number Information
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NPI Number | 1760564199
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Entity Type | Organization
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Legal Business Name | ELDORADO OBSTETRICS AND GYNECOLOGY PA
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/25/2008
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Provider Practice Location Address
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Address Line | 700 WEST CENTRAL SUITE 412
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City | EL DORADO
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State | KS
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Zip | 67042
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Country | US
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Telephone | 316-320-0501
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Fax | 316-321-0503
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Provider Business Mailing Address
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Address Line | 700 WEST CENTRAL SUITE 412
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City | EL DORADO
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State | KS
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Zip | 67042
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Country | US
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Telephone | 316-320-0501
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Fax | 316-321-0503
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Authorized Official
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Title or Position | OBGYN OWNER
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Name | DR. CAMILLE ALETHA RUSSELL MCKESEY
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Credential |
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Telephone | 316-320-0501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0430298
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License Number State | KS
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