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Individual

BRUCE L. PENNINGTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
100 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5289
(740) 446-5697
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5289
(740) 446-5697

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
16694
WV
2085R0202X
Diagnostic Radiology Physician
Primary
35-06-0247
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000007285
ANTHEM BCBS
01
000000193002
UNISON MEDICAID
OH
01
001714061
MOUNTAIN STATE BCBS
05
0118365000
WV
01
0798650
MOLINA MEDICAID
OH
01
300028175
RR MEDICARE
Enumeration date
06/07/2006
Last updated
11/09/2020
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