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General NPI Number Information
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NPI Number | 1407440001
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Entity Type | Organization
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Legal Business Name | DAVID PENNER MD PLLC
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 1801 W BAY DR NW STE 104
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City | OLYMPIA
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State | WA
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Zip | 98502-4310
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Country | US
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Telephone | 360-539-1736
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Fax | 360-350-5610
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | OLYMPIA
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State | WA
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Zip | 98507-0023
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Country | US
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Telephone | 360-539-1736
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Fax | 360-350-5610
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Authorized Official
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Title or Position | DR
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Name | DAVID EUGENE PENNER
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Credential | MD
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Telephone | 360-539-1736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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