Individual
DR. IAN JOSEPH PENNISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6900 N PECOS RD, NORTH LAS VEGAS, NV 89086-4400
(702) 791-9000
Mailing address
6900 N PECOS RD, NORTH LAS VEGAS, NV 89086-4400
(702) 791-9000
Taxonomy
Speciality
Code
Description
License number
State
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
59778
MN
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
59778
MN
2084P0800X
Psychiatry Physician
59778
MN
208VP0000X
Pain Medicine Physician
59778
MN
Other
Enumeration date
04/09/2013
Last updated
06/30/2023
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