Provider Demographics
NPI:1184738643
Name:PENNY, GARY LYNN (MD)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:LYNN
Last Name:PENNY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7711 LOUIS PASTEUR DR
Mailing Address - Street 2:SUITE 812
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3415
Mailing Address - Country:US
Mailing Address - Phone:210-616-0998
Mailing Address - Fax:210-692-7438
Practice Address - Street 1:7711 LOUIS PASTEUR DR
Practice Address - Street 2:SUITE 812
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3415
Practice Address - Country:US
Practice Address - Phone:210-616-0998
Practice Address - Fax:210-692-7438
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ44292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U09RMedicare ID - Type UnspecifiedMEDICARE NUMBER
TXF75519Medicare UPIN