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Individual
BRIAN K. PENROSE
Active
Individual
BRIAN K. PENROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
07001313A
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
13232441-0501
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001293859
ANTHEM
IN
01
—
000001366840
ANTHEM
IN
01
—
13232441-0501
UTAH MEDICAL LICENSE
UT
05
—
201375910
—
IN
01
—
41000341A
IN MEDICAL LICENSE
IN
01
—
738460022
MEDICARE
IN
01
—
IN1933075
MEDICARE
IN
Enumeration date
06/03/2016
Last updated
06/20/2023
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