Robert L Penn, M.D.

Primary specialty

Infectious Disease PhysicianTaxonomy code 207RI0200X

License

04670R Issued in LA

Practice address

1501 Kings Hwy
Department of Medicine, Infectious Disease
Shreveport, LA 71103

Phone

(318) 675-7737

Fax

(318) 675-5666

NPI assigned

Sep 4, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220486400000",
    "number": "1821246737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "DEPARTMENT OF MEDICINE, INFECTIOUS DISEASE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71103",
            "telephone_number": "318-675-7737",
            "fax_number": "318-675-5666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "DEPARTMENT OF MEDICINE, INFECTIOUS DISEASE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71103",
            "telephone_number": "318-675-7737",
            "fax_number": "318-675-5666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "ROBERT",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-04",
        "last_updated": "2008-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "LA",
            "license": "04670R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1195332",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Merrie G Pendergrass, SLP
• Karen M'Liss Pendleton, M.D.
• Rodney La'Ree Pendleton, D.D.S.
• Glenis Joyce Penn
• Lisa Harrison Penn, CAC
• Pennington Facial Plastics, LLC
• Lindsey Alexander Pennington, MD
• Mariana Penny
• Ashton Pennywell
• Brianna Nicole Pennywell

• Infectious Disease Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Infectious Disease Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.