Provider Demographics
NPI:1235234303
Name:PENNER, STEVEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:PENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3-3420 KUHIO HIGHWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1098
Mailing Address - Country:US
Mailing Address - Phone:808-335-0499
Mailing Address - Fax:808-335-0496
Practice Address - Street 1:4382 WAIALO ROAD
Practice Address - Street 2:
Practice Address - City:ELEELE
Practice Address - State:HI
Practice Address - Zip Code:96705
Practice Address - Country:US
Practice Address - Phone:808-335-0499
Practice Address - Fax:808-335-0496
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-12545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine