Provider Demographics
NPI:1194606681
Name:PENSON, JOE (PARA PROFESSIONAL)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:PENSON
Suffix:
Gender:M
Credentials:PARA PROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-4024
Mailing Address - Country:US
Mailing Address - Phone:580-326-7531
Mailing Address - Fax:580-326-2377
Practice Address - Street 1:601 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4024
Practice Address - Country:US
Practice Address - Phone:580-326-7531
Practice Address - Fax:580-326-2377
Is Sole Proprietor?:No
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist