Individual
MR. JAMES HARRY PENROD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1732 KINGSLEY AVE, SUITE 1, ORANGE PARK, FL 32073-4412
(904) 264-0600
(904) 264-8972
Mailing address
1732 KINGSLEY AVE, SUITE 1, ORANGE PARK, FL 32073-4412
(904) 264-0600
(904) 264-8972
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY 3311
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75564
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/21/2006
Last updated
07/08/2007
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