Provider Demographics
NPI:1649293630
Name:PENLAND, HEATH ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:ROBERT
Last Name:PENLAND
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 1:1111 WAYNE RD NW STE 6
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-3573
Mailing Address - Country:US
Mailing Address - Phone:256-288-3333
Mailing Address - Fax:
Practice Address - Street 1:1111 WAYNE RD NW STE 6
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-3573
Practice Address - Country:US
Practice Address - Phone:256-288-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL285782084P0800X
TXM44372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry