Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 51723 | SC |
NPI | 1053474163 |
---|---|
Provider Name | Edward Benjamin Penn JR. |
First Address | Greenville, SC 29615-4536 |
Second Address | Greenville, SC 29615-6306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2006 |
Last Update Date | 17/03/2018 |