Individual
IAN RICHARD PENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
51377 SW OLD PORTLAND RD, SCAPPOOSE, OR 97056-4018
(503) 543-3181
Mailing address
2717 NE 10TH AVE, PORTLAND, OR 97212-3209
(503) 335-8141
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
12/17/2009
Last updated
12/29/2020
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