Individual
MR. DONALD PENZIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5808
(601) 815-4710
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
5203
NC
103TC0700X
Clinical Psychologist
28-387
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114323
—
MS
01
—
680010494
RAILROAD MEDICARE
MS
Enumeration date
05/31/2006
Last updated
11/27/2017
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