Individual
RUSSELL PECKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7200 WYOMING SPGS, SUITE 300, ROUND ROCK, TX 78681-4303
(512) 910-8800
(512) 522-4483
Mailing address
7200 WYOMING SPGS, SUITE 300, ROUND ROCK, TX 78681-4303
(512) 910-8800
(512) 522-4483
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
P5120
TX
207R00000X
Internal Medicine Physician
0102201303
VA
Other
Enumeration date
07/20/2006
Last updated
08/08/2017
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