Individual
ANTHONY RUSSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
821 GRAND AVENUE PKWY STE 200, PFLUGERVILLE, TX 78660-2197
(512) 251-5586
(512) 549-6260
Mailing address
821 GRAND AVENUE PKWY STE 200, PFLUGERVILLE, TX 78660-2197
(512) 251-5586
(512) 549-6260
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G0039
TX
Other
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
Enumeration date
12/06/2005
Last updated
07/30/2025
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