Doctor Name: | JACKSON W PENRY |
NPI Number: | 1003055401 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | A114302 |
Business Practice Address: | 27700 Medical Center Road-radiology Department Mission Viejo, CA - 926916426 |
Business Phone Number: | 9493647744 |
Business Fax Number: | |
Mailing Address: | Dept La 21789, PASADENA |
State: | CA |
Postal Code: | 911851789 |
Phone Number: | 9492638620 |
Fax Number: | 8004097005 |
NPI Enumeration Date: | 02/10/2009 |
NPI Last Update Date: | 07/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085R0202X |
License Number: | A114302 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Diagnostic Radiology |
Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |