Provider Demographics
NPI:1164459798
Name:PENNEY, BRETT A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:PENNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 W. IRONWOOD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COEUR D'ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-765-1455
Mailing Address - Fax:208-667-8655
Practice Address - Street 1:980 W. IRONWOOD
Practice Address - Street 2:SUITE 101
Practice Address - City:COEUR D'ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-765-1455
Practice Address - Fax:208-667-8655
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-8797207V00000X
IDM8797207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806682500Medicaid
IDH89965Medicare UPIN
ID1111936Medicare ID - Type Unspecified