Healthcare Provider Details

I. General information

NPI: 1407827314
Provider Name (Legal Business Name): MILTON EARL PENN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 PATTERSON ST STE 715
NASHVILLE TN
37203
US

IV. Provider business mailing address

PO BOX 17798
NASHVILLE TN
37217
US

V. Phone/Fax

Practice location:
  • Phone: 615-321-2711
  • Fax: 615-321-2714
Mailing address:
  • Phone: 615-321-2711
  • Fax: 615-321-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPM452
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: