Healthcare Provider Details

I. General information

NPI: 1447271382
Provider Name (Legal Business Name): THOMAS PENMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 N 1ST ST STE 104
FRESNO CA
93726-0522
US

IV. Provider business mailing address

7058 N WEST AVE # 175
FRESNO CA
93711-0462
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-5860
  • Fax: 559-224-3969
Mailing address:
  • Phone: 559-708-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000E21961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: