Organization
WEST COAST SURGICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAIGE KOENIG PENNEBACKER (MD)
(941) 761-0500
Entity
Organization
Contact information
Practice address
5953 17TH AVE W, BRADENTON, FL 34209-7836
(941) 746-8127
(941) 746-8127
Mailing address
PO BOX 14731, BRADENTON, FL 34280-4731
(941) 545-4002
(941) 748-6195
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME62365
FL
Other
Enumeration date
02/23/2012
Last updated
01/24/2018
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