Individual
WILLIAM J PENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 TAHOMA BLVD, SUITE 102, YELM, WA 98597-7735
(360) 458-7761
Mailing address
201 TAHOMA BLVD, SUITE 102, YELM, WA 98597-7735
(360) 458-7761
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00020401
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018621
—
WA
01
—
62141
L&I - WORKERS COMP
WA
01
—
T00079
REGENCE
WA
Enumeration date
05/26/2006
Last updated
09/20/2013
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