Individual
ERIC BRIAN PENEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
820 PRUDENTIAL DR STE 304, JACKSONVILLE, FL 32207-8205
(904) 202-3860
(904) 202-3846
Mailing address
PO BOX 746638, ATLANTA, GA 30374-6638
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A125287
CA
207R00000X
Internal Medicine Physician
MD.30762
AL
207R00000X
Internal Medicine Physician
ME124402
FL
208M00000X
Hospitalist Physician
Primary
ME124402
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015085500
—
FL
01
—
P01497428
RAILROAD MEDICARE
FL
Enumeration date
05/19/2009
Last updated
08/01/2024
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