Pendleton, Russell
Pendleton, Russell is an sole proprietor health care provider with primary practice located at 6312 Azle Ave , Lake Worth TX 76135-2442. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Pendleton, Russell can be contacted via phone (817) 238-8400.Contact Information
Primary practice address
6312 Azle Ave
Lake Worth TX 76135-2442
Phone: (817) 238-8400
Fax: (817) 238-8401
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery | 213ES0103X | 1916 | Texas |
Profile Details
NPI number | 1932356789 |
---|---|
LBN Legal business name | Pendleton, Russell |
Credentials | Doctor of Podiatric Medicine (DPM) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Aug 23rd, 2008 |
Last updated | Nov 28th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1932356789 | NPPES |
Texas | MEDICAID | 214330702 | |
Texas | MEDICAID | 214330704 |
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