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General NPI Number Information
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NPI Number | 1265851646
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Entity Type | Individual
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Provider Name | CHRISTOPHER ALAN PENTON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2014
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 31 TOWN CENTER SQ STE 200
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City | HATTIESBURG
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State | MS
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Zip | 39402-7040
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Country | US
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Telephone | 601-620-6225
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Fax | 800-331-0242
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Provider Business Mailing Address
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Address Line | 31 TOWN CENTER SQ STE 200
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City | HATTIESBURG
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State | MS
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Zip | 39402-7040
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Country | US
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Telephone | 601-620-6225
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Fax | 800-331-0242
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 28825
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207PS0010X
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Taxonomy Name | Sports Medicine (Emergency Medicine) Physician
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License Number | 28825
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License Number State | MS
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