Provider Demographics
NPI:1689069478
Name:PENNY, WILLIAM GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GREGORY
Last Name:PENNY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72902-1426
Mailing Address - Country:US
Mailing Address - Phone:479-452-9416
Mailing Address - Fax:479-242-1990
Practice Address - Street 1:7301 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4100
Practice Address - Country:US
Practice Address - Phone:479-452-9416
Practice Address - Fax:479-242-1990
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-11963207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology