Individual
GORDON E PENNEBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1344 HAILE ST, CAMDEN, SC 29020-3076
(803) 432-1996
(803) 424-2703
Mailing address
PO BOX 1259, SENTINEL HEALTH PARTNERS PA BUSINESS OFFICE, CAMDEN, SC 29021-1259
(803) 713-8350
(803) 713-8433
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18265
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080181551
RAILROAD MEDICARE PIN
SC
05
—
182652
—
SC
01
—
B5656
MEDCOST
—
Enumeration date
05/17/2006
Last updated
02/24/2012
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