Individual
DR. CHARLES EDWARD PENNIX III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 464-2973
Mailing address
1207 SIDNEY ST, SAINT LOUIS, MO 63104-4312
(513) 254-6849
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036.138462
IL
Other
Enumeration date
07/18/2011
Last updated
12/23/2021
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