Provider Demographics
NPI:1659968394
Name:PENROD, WILLIAM BRIAN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRIAN
Last Name:PENROD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25590 C RD
Mailing Address - Street 2:
Mailing Address - City:SOLDIER
Mailing Address - State:KS
Mailing Address - Zip Code:66540-9245
Mailing Address - Country:US
Mailing Address - Phone:785-851-9330
Mailing Address - Fax:
Practice Address - Street 1:25590 C RD
Practice Address - Street 2:
Practice Address - City:SOLDIER
Practice Address - State:KS
Practice Address - Zip Code:66540-9245
Practice Address - Country:US
Practice Address - Phone:785-834-2099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist