Individual
REBECCA L PENGILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1705 WAVERLY DR SE, ALBANY, OR 97322-6952
(541) 967-8221
Mailing address
444 NW ELKS DR, CORVALLIS, OR 97330-3745
(541) 967-8221
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5123
SD
207Q00000X
Family Medicine Physician
Primary
MD182380
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5611360
—
SD
Enumeration date
01/12/2006
Last updated
06/29/2021
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