Provider Demographics
NPI:1184627259
Name:PENOYAR, CHRISTOPHER WEBB (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WEBB
Last Name:PENOYAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 NORTH 13TH LOOP
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-2169
Mailing Address - Country:US
Mailing Address - Phone:360-426-3862
Mailing Address - Fax:360-427-1743
Practice Address - Street 1:1812 NORTH 13TH LOOP
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-2169
Practice Address - Country:US
Practice Address - Phone:360-426-3862
Practice Address - Fax:360-427-1743
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPE0423OtherREGENCE BLUE SHEILD
E72750Medicare UPIN
WA910836763OtherTAX ID PUBLIC HOSPITAL DISTRICT
WAG000200697Medicare PIN
W005337OtherCHAMPUS
WA64149OtherLABOR AND INDUSTRIES
080177734OtherRAILROAD MEDICARE
91-1456199OtherTAX ID
WA91145619901OtherKPS INSURANCE
WA1300243Medicaid