# ANTHONY RUSSO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1700860400
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | G0039 | TX | Yes |

## Other

- **Enumeration date:** 12/06/2005
- **Last updated:** 07/30/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00B91R | BLUE CROSS BLUE SHIELD TX | TX |
| 01 | — | 115675 | AETNA | TX |
| 01 | — | G0039 | STATE MEDICAL LICENSE | TX |