Russell, Peggy M
Russell, Peggy M is an individual health care provider with primary practice located at 1108 Lavaca St 110-320, Austin TX 78701-2172. She recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as her primary health care specialty. Russell, Peggy M can be contacted via phone (512) 477-4088.Contact Information
Primary practice address
1108 Lavaca St 110-320
Austin TX 78701-2172
Phone: (512) 477-4088
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Geriatric Medicine | 207RG0300X | F4461 | Texas |
Profile Details
| NPI number | 1679598718 |
|---|---|
| LBN Legal business name | Russell, Peggy M |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 12th, 2006 |
| Last updated | May 5th, 2011 - about 14 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 | 1679598718 | NPPES |
| Texas | MEDICAID | 097796902 | |
| Texas | Other | 110180474 | |
| Texas | Other | 82020J |
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