Physician Compare National (NPI:1114005584)

HEALTHCARE PROVIDER: DAVID EUGENE PENNER MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1114005584
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3375602055
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20191029003445
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	PENNER
	Individual professional last name
Provider First Name	DAVID
	Individual professional first name
Provider Middle Name	EUGENE
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2006
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	324 W BAY DR NW
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 214
	Group Practice or individual's line 2 address
City	OLYMPIA
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	985024926
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3605391736
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y