Avery Ryan Pennywell, MD
Student in an Organized Health Care Education/Training Program in Dallas, TX. Individual provider (NPI-1).
NPI number1316625833
StatusActive
Last updated in NPPESJul 5, 2023
Details
- NPI
- 1316625833
- Entity type
- Individual (NPI-1)
- Name
- Avery Ryan Pennywell
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 5, 2023
- Certification date
- Jul 5, 2023
- Last updated
- Jul 5, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | TX | Yes |
Practice location
5323 Harry Hines BlvdDallas, TX 75390-9006
Phone 214-648-2168 · Fax 214-648-7517
Mailing address
5323 Harry Hines BlvdDallas, TX 75390-9006
Phone 214-648-2168 · Fax 214-648-7517
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