Individual
JOHN R PENTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
950 BRECKENRIDGE LN STE 200, LOUISVILLE, KY 40207-5929
(502) 893-6777
(502) 899-5535
Mailing address
5200 COMMERCE CROSSINGS DR FL 3, LOUISVILLE, KY 40229-2182
(502) 253-4924
(502) 489-5750
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
21548
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000247085
ANTHEM
—
01
—
50000082
PASSPORT
—
05
—
64215486
—
KY
01
—
P01026547
MEDICARE RAILROAD
KY
Enumeration date
08/11/2005
Last updated
12/07/2020
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