Penczak, Frederick William

Penczak, Frederick William is an individual health care provider with primary practice located at 78 Creekside Dr , San Rafael CA 94903-1055. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Penczak, Frederick William can be contacted via phone (707) 939-7411.

Contact Information

Primary practice address
78 Creekside Dr San Rafael CA 94903-1055
Phone: (707) 939-7411
Fax: (707) 939-1617
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 00A685120 California

Profile Details

NPI number 1841379070
LBN Legal business name Penczak, Frederick William
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 6th, 2006
Last updated Apr 25th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841379070 NPPES
California MEDICAID 00A685120

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