Organization
ADVANCED FOOT AND ANKLE ASSOCIATES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL OLIN PENDLETON DPM (OWNER/PHYSICIAN)
(817) 238-8400
Entity
Organization
Contact information
Practice address
6312 AZLE AVE, LAKE WORTH, TX 76135-2442
(817) 238-8400
(817) 238-8401
Mailing address
6312 AZLE AVE, LAKE WORTH, TX 76135-2442
(817) 238-8400
(817) 238-8401
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
1916
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0029WA
BCBS TX
TX
05
—
218408702
—
TX
05
—
218408703
—
TX
Enumeration date
06/14/2010
Last updated
11/28/2023
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