Individual
DR. DONALD E PENN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 MAIN ST, SUITE 500A, PEORIA, IL 61606
(309) 672-4980
(309) 671-2944
Mailing address
PO BOX 365, MORTON, IL 61550-0365
(309) 672-4980
(309) 671-2944
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036062844
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008850
HEALTH ALLIANCE
IL
05
—
036062844
—
IL
01
—
07215152
BLUE CROSS
IL
01
—
100004399
RAILROAD MEDICARE
IL
01
—
166330
HEALTHLINK
IL
01
—
371221637
FEDERAL TAX IDENTIFICATIO
IL
01
—
4282553
AETNA HEALTH PLANS
IL
01
—
776530
MEDICARE GROUP NUMBER
IL
01
—
IL0101
JOHN DEERE
IL
Enumeration date
06/15/2006
Last updated
05/29/2009
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