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Individual
DR. RUSSELL HERBERT PACQUETTE
Active
Individual
DR. RUSSELL HERBERT PACQUETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
79222
GA
207R00000X
Internal Medicine Physician
Primary
U7131
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003208359A
—
GA
01
—
4301104108
STATE LICENSE
MI
Enumeration date
09/22/2010
Last updated
05/15/2024
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