Provider Demographics
NPI:1407827314
Name:PENN, MILTON EARL (DPM)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:EARL
Last Name:PENN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17798
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217
Mailing Address - Country:US
Mailing Address - Phone:615-321-2711
Mailing Address - Fax:615-321-2714
Practice Address - Street 1:1916 PATTERSON ST
Practice Address - Street 2:STE 715
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-321-2711
Practice Address - Fax:615-321-2714
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM452213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3734591Medicaid
TN4123039OtherBCBS
TN11-3776553OtherDEPENNDABLE TIN
TNU51982Medicare UPIN
TN3734591Medicaid
TN3352253Medicare PIN
TN4123039OtherBCBS