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NPI Code Detail

MEDICARE: DR. RICHARD T PENLY MD

MEDICARE: DR. RICHARD T PENLY 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
1207Q00000XFamily Medicine PhysicianME80379FL

Other Identifiers

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

General Provider Information

NPI Number : 1194782185
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD T PENLY MD
Provider Business Mailing Address
First Line : 6005 65TH ST
Second Line :
City : VERO BEACH
State : FL
Zip : 32967-5231
Country : US
Telephone Number : 772-532-2151
Fax Number :
Provider Business Practice Location Address
First Line : 1600 37TH ST
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-4863
Country : US
Telephone Number : 772-532-2151
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 02/27/2022

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