Provider Demographics
NPI:1578554770
Name:PENNY, JANET ADELE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ADELE
Last Name:PENNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SE COURT PL
Mailing Address - Street 2:L01
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-276-0250
Mailing Address - Fax:541-276-0253
Practice Address - Street 1:1600 SE COURT PL
Practice Address - Street 2:L01
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801
Practice Address - Country:US
Practice Address - Phone:541-276-0250
Practice Address - Fax:541-276-0253
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19780208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR081091Medicaid
F84597Medicare UPIN