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Individual
GORDON E PENNEBAKER
Active
Individual
GORDON E PENNEBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18265
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080181551
RAILROAD MEDICARE PIN
SC
05
—
182652
—
SC
01
—
B5656
MEDCOST
—
Enumeration date
05/17/2006
Last updated
02/24/2012
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