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1447568597

NPI Code Detail

MEDICARE: DR. RUSSELL HERBERT PACQUETTE MD

MEDICARE: DR. RUSSELL HERBERT PACQUETTE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	79222	GA
2	207R00000X	Internal Medicine Physician	U7131	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4301104108	OTHER	MI	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447568597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL HERBERT PACQUETTE MD

Provider Business Mailing Address
First Line	:	836 E. 65TH STREET
Second Line	:	SUITE 20
City	:	SAVANNAH
State	:	GA
Zip	:	31405
Country	:	US
Telephone Number	:	912-819-7878
Fax Number	:	912-819-3555

Provider Business Practice Location Address
First Line	:	11251 FONDREN RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-5507
Country	:	US
Telephone Number	:	281-707-7362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	05/15/2024

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Directions to “ DR. RUSSELL HERBERT PACQUETTE MD” Practice Location

Language	Start Address	Practice Location

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