Provider Demographics
NPI:1881642536
Name:WEST, PENNY C (MD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:C
Last Name:WEST
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 1:420 N HIGHWAY 67 STE D1
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-6069
Mailing Address - Country:US
Mailing Address - Phone:972-291-7181
Mailing Address - Fax:972-291-0687
Practice Address - Street 1:420 N HIGHWAY 67 STE D1
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-6069
Practice Address - Country:US
Practice Address - Phone:972-291-7181
Practice Address - Fax:972-291-0687
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043762-03Medicaid
TXF27555Medicare UPIN
TX8D8269Medicare PIN
TX1043762-03Medicaid