Provider Demographics
NPI:1073569737
Name:PENNINGS, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:PENNINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:750 N SYRINGA ST
Mailing Address - Street 2:STE 205
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5275
Mailing Address - Country:US
Mailing Address - Phone:208-262-0945
Mailing Address - Fax:208-415-0150
Practice Address - Street 1:750 N SYRINGA ST
Practice Address - Street 2:STE 205
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5275
Practice Address - Country:US
Practice Address - Phone:208-262-0945
Practice Address - Fax:208-415-0150
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM-6485208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID020050503OtherRAILROAD MEDICARE
ID020050503OtherRAILROAD MEDICARE
IDE71583Medicare UPIN