Individual
PEGGY M RUSSELL
Active
Individual
PEGGY M RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
F4461
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
097796902
—
TX
01
—
110180474
MEDICARE RAILROAD
TX
01
—
82020J
BCBS TEXAS
TX
Enumeration date
07/12/2006
Last updated
05/05/2011
Update your record
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