Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 13129 | NE |
NPI | 1013937374 |
---|---|
Provider Name | Robert G Penn |
First Address | Omaha, NE 68114-4129 |
Second Address | Omaha, NE 68114-4129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 13/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01565 | BCBS (01) | NE |
0923557 | (05) | IA |
202111902 | (05) | MO |
D17252 | (02) |