MEDICARE: ERIC R PENNIMAN DO

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	207Q00000X	Family Medicine Physician	3117	TN

General Provider Information

NPI Number	:	1952413197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC R PENNIMAN DO

Provider Business Mailing Address
First Line	:	1275 DICK LONAS RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1382
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 DICK LONAS RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1382
Country	:	US
Telephone Number	:	865-584-4747
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/18/2019

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