Individual
BRUCE L. PENNINGTON
Active
Individual
BRUCE L. PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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