Provider Demographics
NPI:1356667687
Name:PENNINGTON, BENJAMEN E (IDMT)
Entity Type:Individual
Prefix:
First Name:BENJAMEN
Middle Name:E
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HOUX DR
Mailing Address - Street 2:
Mailing Address - City:WHITEMAN AFB
Mailing Address - State:MO
Mailing Address - Zip Code:65305-1130
Mailing Address - Country:US
Mailing Address - Phone:660-238-7570
Mailing Address - Fax:
Practice Address - Street 1:310 HOUX DR
Practice Address - Street 2:
Practice Address - City:WHITEMAN AFB
Practice Address - State:MO
Practice Address - Zip Code:65305-1130
Practice Address - Country:US
Practice Address - Phone:660-238-7570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians