Penry, Jackson W

Penry, Jackson W is an individual health care provider with primary practice located at 27700 Medical Center Road-Radiology Department , Mission Viejo CA 92691-6426. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Penry, Jackson W can be contacted via phone (949) 364-7744.

Contact Information

Primary practice address
27700 Medical Center Road-Radiology Department Mission Viejo CA 92691-6426
Phone: (949) 364-7744
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X A114302 California

Profile Details

NPI number 1003055401
LBN Legal business name Penry, Jackson W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 10th, 2009
Last updated Jul 29th, 2014 - about 10 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 1003055401 NPPES
California Other 00A1143020 BS/BC OF CA
California MEDICAID 1003055401 BS/BC OF CA
California MEDICAID 0A1143020 BS/BC OF CA

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