Healthcare Provider Details

I. General information

NPI: 1982822540
Provider Name (Legal Business Name): DAVID MORGAN PENN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NW 26TH ST MAYO CLINIC HEALTH SYSTEM
OWATONNA MN
55060-5503
US

IV. Provider business mailing address

2200 NW 26TH ST
OWATONNA MN
55060-5503
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-1120
  • Fax:
Mailing address:
  • Phone: 507-451-1120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number37112
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number5217
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number52857
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: