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NPI Code Detail

MEDICARE: PARKER TRENT RUSSELL MD

MEDICARE: PARKER TRENT RUSSELL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician2024027874MO
2207R00000XInternal Medicine Physician2024027874MO

General Provider Information

NPI Number : 1770100026
Entity Type Code : Individual
Provider Name (Legal Business Name) : PARKER TRENT RUSSELL MD
Provider Business Mailing Address
First Line : 54 HOSPITAL DR
Second Line :
City : OSAGE BEACH
State : MO
Zip : 65065-3050
Country : US
Telephone Number : 573-348-8000
Fax Number : 573-302-2297
Provider Business Practice Location Address
First Line : 54 HOSPITAL DR
Second Line :
City : OSAGE BEACH
State : MO
Zip : 65065-3050
Country : US
Telephone Number : 573-348-8000
Fax Number : 573-302-2297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2020
Last Update Date : 01/08/2026

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Directions to “ PARKER TRENT RUSSELL MD” Practice Location

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