Provider Demographics
NPI:1265851646
Name:PENTON, CHRISTOPHER ALAN (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:PENTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 TOWN CENTER SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7040
Mailing Address - Country:US
Mailing Address - Phone:601-620-6225
Mailing Address - Fax:800-331-0242
Practice Address - Street 1:31 TOWN CENTER SQ STE 200
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7040
Practice Address - Country:US
Practice Address - Phone:601-620-6225
Practice Address - Fax:800-331-0242
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28825207QS0010X, 207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine