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Contact Information

RUSSELL D DEIDIKER, MD
1212 WEBER RD
SUITE 205
FARMINGTON, MO63640-3325
 Phone: 573-756-4581
 Fax: 573-756-7197
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anatomic Pathology & Clinical Pathology

207ZP0102X 22 Physician/Pathology
Indicates primary specialty

NPI Profile & details for RUSSELL D DEIDIKER · (Male)

NPI # 1841265345
Status Active
Credentials MD
Entity Individual
Enumeration date 02/20/2006
Last updated 07/08/2007 - About 19 years ago
Sole proprietor 1 Not specified
Identifiers
  • MO License # 113238
  • MO Medicaid 208729707
Hospital affiliation(s)
  • MISSOURI DELTA MEDICAL CENTER - (Acute Care)
    1008 NORTH MAIN ST
    SIKESTON, MO 63801
  • PARKLAND HEALTH CENTER - (Acute Care)
    1101 W LIBERTY
    FARMINGTON, MO 63640
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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