Individual
DR. RAFFAELE PENNELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3808 S GREYSTONE CT, SPRINGFIELD, MO 65804
(417) 889-3332
(417) 881-1410
Mailing address
3808 S GREYSTONE CT, SPRINGFIELD, MO 65804
(417) 889-3332
(417) 881-1410
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
110288
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
156123001
—
AR
05
—
208269902
—
MO
01
—
31905
MO BLUE SHIELD
MO
01
—
81292
ARK BLUE SHIELD
AR
Enumeration date
02/05/2007
Last updated
12/08/2016
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