Individual
KEVIN M PENWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11808 S MAY AVE, OKLAHOMA CITY, OK 73170-2560
(405) 735-2370
(405) 735-2369
Mailing address
5701 SE 74TH ST, SUITE E, OKLAHOMA CITY, OK 73135-1106
(405) 600-6869
(405) 600-6978
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
3873
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100113200D
—
OK
Enumeration date
09/21/2005
Last updated
02/16/2015
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