Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | ME53420 | FL |
NPI | 1700808169 |
---|---|
Provider Name | James Henry Pennington |
First Address | Pensacola, FL 32504-8771 |
Second Address | Pensacola, FL 32504-8771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E49305 | (02) | FL |