MEDICARE: DR. RUSSELL PENDLETON DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	1916	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932356789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL PENDLETON DPM

Provider Business Mailing Address
First Line	:	6312 AZLE AVE
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2442
Country	:	US
Telephone Number	:	817-238-8400
Fax Number	:	817-238-8401

Provider Business Practice Location Address
First Line	:	6312 AZLE AVE
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2442
Country	:	US
Telephone Number	:	817-238-8400
Fax Number	:	817-238-8401

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

Provider Enumeration Date	:	08/23/2008
Last Update Date	:	11/28/2023

Similar Medicare Providers

1447229224 — JILL A GRAMER DO
Practice Location Address:

6312 AZLE AVE # 200
FORT WORTH, TX
76135-2442

Practice Phone: 682-841-1056
Practice Fax: 682-841-1161

1649205568 — JULIO C FAJARDO D.C.
Practice Location Address:

6316 AZLE AVE , STE 600
FORT WORTH, TX
76135-2442

Practice Phone: 817-237-5900
Practice Fax: 817-238-6318

1578767661 — AFFORDABLE DENTURES & IMPLANTS - TEXAS, PLLC
Practice Location Address:

6316 AZLE AVE , SUITE 200
LAKE WORTH, TX
76135-2442

Practice Phone: 817-237-7377
Practice Fax:

1568783553 — ADVANCED FOOT AND ANKLE ASSOCIATES PLLC
Practice Location Address:

6312 AZLE AVE
LAKE WORTH, TX
76135-2442

Practice Phone: 817-238-8400
Practice Fax: 817-238-8401

1578884029 — JILL GRAMER DO PA
Practice Location Address:

6312 AZLE AVE STE 200
FORT WORTH, TX
76135-2442

Practice Phone: 682-841-1056
Practice Fax: 682-841-1161

1750733119 — MARK THOMPSON DPM
Practice Location Address:

6312 AZLE AVE
LAKE WORTH, TX
76135-2442

Practice Phone: 817-238-8400
Practice Fax: 817-238-8401

Directions to “ DR. RUSSELL PENDLETON DPM” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.