Provider Demographics
NPI:1780386169
Name:PENN, EARL III
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:
Last Name:PENN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 LEE RD UNIT 389
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2572
Mailing Address - Country:US
Mailing Address - Phone:440-588-6588
Mailing Address - Fax:
Practice Address - Street 1:6121 ALLANWOOD DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-4541
Practice Address - Country:US
Practice Address - Phone:440-588-6588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRY069575172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver