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Individual
PENNI M RUSSO-GOING
Active
Individual
PENNI M RUSSO-GOING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M0549
TX
208600000X
Surgery Physician
M0549
TX
2086S0127X
Trauma Surgery Physician
M0549
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1749160-01
—
TX
Enumeration date
11/17/2005
Last updated
04/01/2011
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