Individual
DR. MICHAEL WILLIAM PENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2294
(817) 321-0404
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3194
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2004009990
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208985002
—
MO
Enumeration date
06/23/2006
Last updated
10/03/2022
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