Individual
PAIGE KOENIG PENNEBACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
315 75TH ST W, BRADENTON, FL 34209-3201
(941) 761-0500
(855) 521-2857
Mailing address
PO BOX 14731, BRADENTON, FL 34280-4731
(941) 761-0500
(941) 761-0400
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
ME62365
FL
Other
Enumeration date
10/13/2005
Last updated
10/03/2018
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