Provider Demographics
NPI:1073767968
Name:DRS PENNER NORRIS AND ROUTMAN PA
Entity Type:Organization
Organization Name:DRS PENNER NORRIS AND ROUTMAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:PENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-967-4400
Mailing Address - Street 1:5600 PGA BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3900
Mailing Address - Country:US
Mailing Address - Phone:561-627-8500
Mailing Address - Fax:561-624-5885
Practice Address - Street 1:130 JFK DR
Practice Address - Street 2:STE 201
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1141
Practice Address - Country:US
Practice Address - Phone:561-967-4400
Practice Address - Fax:561-433-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30380207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL37215400Medicaid
FL58711Medicare PIN
FL37215400Medicaid
FL51748Medicare PIN
FLG43200Medicare UPIN
FLD85886Medicare UPIN
FL50805Medicare PIN
FLG81770Medicare UPIN