Healthcare Provider Details

I. General information

NPI: 1538112792
Provider Name (Legal Business Name): DONALD W. PENNINGTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9499 W CHARLESTON BLVD STE 200
LAS VEGAS NV
89117-7147
US

IV. Provider business mailing address

9499 W CHARLESTON BLVD STE 200
LAS VEGAS NV
89117-7147
US

V. Phone/Fax

Practice location:
  • Phone: 29-339-3937
  • Fax: 702-933-6789
Mailing address:
  • Phone: 702-933-9393
  • Fax: 702-933-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO3274
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: