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General NPI Number Information
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NPI Number | 1043394562
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Entity Type | Organization
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Legal Business Name | RICHARD P. JENNINGS D.O. S. C.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 109 WARREN ST
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City | BEAVER DAM
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State | WI
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Zip | 53916
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Country | US
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Telephone | 920-887-8646
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Fax | 920-887-8953
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Provider Business Mailing Address
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Address Line | 109 WARREN ST SUITE #1
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City | BEAVER DAM
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State | WI
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Zip | 53916-3082
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Country | US
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Telephone | 920-887-8646
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Fax | 920-887-8953
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. RICHARD P JENNINGS
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Credential | DO
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Telephone | 920-887-8646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 29143
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License Number State | WI
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