Provider Demographics
NPI:1124393467
Name:PENNELL, CHRISTOPHER PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:PENNELL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:621 S NEW BALLAS RD STE 483A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8259
Mailing Address - Country:US
Mailing Address - Phone:314-251-5940
Mailing Address - Fax:314-251-5813
Practice Address - Street 1:621 S NEW BALLAS RD STE 483A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8259
Practice Address - Country:US
Practice Address - Phone:314-251-5940
Practice Address - Fax:314-251-5813
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4631962086S0120X
MO20220294482086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery