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NPI Code Detail

MEDICARE: DR. CHRISTOPHER WEBB PENOYAR D.O.

MEDICARE: DR. CHRISTOPHER WEBB PENOYAR D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOP00001087WA

General Provider Information

NPI Number : 1184627259
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTOPHER WEBB PENOYAR D.O.
Provider Business Mailing Address
First Line : 1812 NORTH 13TH LOOP
Second Line :
City : SHELTON
State : WA
Zip : 98584-2169
Country : US
Telephone Number : 360-426-3862
Fax Number : 360-427-1743
Provider Business Practice Location Address
First Line : 1812 NORTH 13TH LOOP
Second Line :
City : SHELTON
State : WA
Zip : 98584-2169
Country : US
Telephone Number : 360-426-3862
Fax Number : 360-427-1743
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 04/03/2017

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