Provider Demographics
NPI:1891281648
Name:PENNINGTON, SAUL HARRIS (PA-C)
Entity Type:Individual
Prefix:
First Name:SAUL
Middle Name:HARRIS
Last Name:PENNINGTON
Suffix:
Gender:M
Credentials:PA-C
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 802
Mailing Address - Street 2:
Mailing Address - City:ASPERMONT
Mailing Address - State:TX
Mailing Address - Zip Code:79502-0802
Mailing Address - Country:US
Mailing Address - Phone:940-989-3551
Mailing Address - Fax:
Practice Address - Street 1:821 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ASPERMONT
Practice Address - State:TX
Practice Address - Zip Code:79502-2029
Practice Address - Country:US
Practice Address - Phone:940-989-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-05
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical