Individual
DR. JON FREDRICK PENNYCUFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MD046440
DC
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
75417-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/25/2014
Last updated
09/22/2021
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