MEDICARE: DR. DALLAS R PENROD D.P.M.

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	0045	NV

General Provider Information

NPI Number	:	1558668475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALLAS R PENROD D.P.M.

Provider Business Mailing Address
First Line	:	5605 RIGGINS CT STE 103
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-6575
Country	:	US
Telephone Number	:	775-826-3668
Fax Number	:	775-826-5121

Provider Business Practice Location Address
First Line	:	5605 RIGGINS CT STE 103
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-6575
Country	:	US
Telephone Number	:	775-826-3668
Fax Number	:	775-826-5121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2011
Last Update Date	:	02/13/2011

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