| Doctor Name: | MR. JOHN PAUL PENKERT |
| NPI Number: | 1336202654 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PMHMP |
| License Number: | |
| Business Practice Address: | 8495 Crater Lake Hwy White City, OR - 975033011 |
| Business Phone Number: | 5418262111 |
| Business Fax Number: | |
| Mailing Address: | 2050 Andover Way, MEDFORD |
| State: | OR |
| Postal Code: | 975014204 |
| Phone Number: | 5417727182 |
| Fax Number: | |
| NPI Enumeration Date: | 12/18/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |