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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 last year

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932356789 NPPES
Texas MEDICAID 214330702
Texas MEDICAID 214330704

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