Individual
DR. DOUGLAS MICHAEL PENNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1906 SOUTHSIDE BLVD, JACKSONVILLE, FL 32216-1930
(904) 724-3083
(904) 727-9103
Mailing address
705 WELLS RD STE 300, ORANGE PARK, FL 32073-2982
(904) 282-6331
(904) 619-1080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS4561
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
068835500
—
FL
01
—
080148958
MEDICARE RAILROAD
FL
Enumeration date
07/19/2006
Last updated
08/24/2022
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