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General NPI Number Information
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NPI Number | 1669545067
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Entity Type | Organization
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Legal Business Name | GOLDEN TRIANGLE FAMILY CARE CENTER
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 10/13/2024
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Provider Practice Location Address
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Address Line | 615 W ROUND BUNCH RD
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City | BRIDGE CITY
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State | TX
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Zip | 77611-2434
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Country | US
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Telephone | 409-735-7305
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Fax | 888-972-9401
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Provider Business Mailing Address
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Address Line | 615 W ROUND BUNCH RD
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City | BRIDGE CITY
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State | TX
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Zip | 77611-2434
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Country | US
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Telephone | 409-735-7305
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Fax | 409-792-0201
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | CHRISTOPHER PAUL PENNING
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Credential | DO
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Telephone | 409-735-7305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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