Provider Demographics
NPI:1699007237
Name:PENN, CHESTER HOWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:HOWARD
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 1578
Mailing Address - Street 2:
Mailing Address - City:CALLAHAN
Mailing Address - State:FL
Mailing Address - Zip Code:32011-1578
Mailing Address - Country:US
Mailing Address - Phone:904-879-2552
Mailing Address - Fax:904-879-6360
Practice Address - Street 1:542067 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:CALLAHAN
Practice Address - State:FL
Practice Address - Zip Code:32011-8110
Practice Address - Country:US
Practice Address - Phone:904-879-2552
Practice Address - Fax:904-879-6360
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3421213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist