Provider Demographics
NPI:1184638967
Name:PENNINGTON, JAY BURTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:BURTON
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1242
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-1242
Mailing Address - Country:US
Mailing Address - Phone:512-863-2117
Mailing Address - Fax:512-869-0946
Practice Address - Street 1:2000 SCENIC DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7726
Practice Address - Country:US
Practice Address - Phone:512-863-2117
Practice Address - Fax:512-869-0946
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2678207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology