Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | DPM452 | TN |
NPI | 1407827314 |
---|---|
Provider Name | Dr. Milton Earl Penn |
First Address | Nashville, TN 37217 |
Second Address | Nashville, TN 37203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 26/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3734591 | (05) | TN |
4123039 | BCBS (01) | TN |
U51982 | (02) | TN |