Individual
DR. RICHARD SIDDALL PENNEBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
57 CROSS PARK COURT, GREENVILLE, SC 29605-4264
(864) 797-6044
(864) 797-6198
Mailing address
ONE INDEPENDENCE POINTE, SUITE 212, GREENVILLE, SC 29615-4566
(864) 797-6044
(864) 797-6198
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12799
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TL5018
—
SC
Enumeration date
05/05/2006
Last updated
09/14/2011
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