Provider Demographics
NPI:1447271382
Name:PENMAN, THOMAS (DPM)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PENMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7058 N WEST AVE
Mailing Address - Street 2:# 175
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0462
Mailing Address - Country:US
Mailing Address - Phone:559-708-7928
Mailing Address - Fax:
Practice Address - Street 1:4820 N 1ST ST STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0522
Practice Address - Country:US
Practice Address - Phone:559-226-5860
Practice Address - Fax:559-224-3969
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000E21961213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E21961Medicaid
CA000E21960Medicaid
CA000E21960Medicaid
CA000E21960Medicare PIN
CA4176430001Medicare NSC
CA000E21961Medicare PIN
CA000E21961Medicaid