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Individual
MARK S PENNER
Active
Individual
MARK S PENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
20A8037
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX80370
—
CA
01
—
020A80370
BLUE SHIELD
CA
01
—
P00273019
RAILROAD MEDICARE
CA
Enumeration date
06/29/2006
Last updated
07/08/2007
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