Provider Demographics
NPI:1063590297
Name:PENNEY, JEFFREY FREEMAN (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:FREEMAN
Last Name:PENNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 SOUTH MCCORMICK
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4731
Mailing Address - Country:US
Mailing Address - Phone:928-445-8400
Mailing Address - Fax:928-776-0208
Practice Address - Street 1:141 SOUTH MCCORMICK
Practice Address - Street 2:SUITE 200
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4731
Practice Address - Country:US
Practice Address - Phone:928-445-8400
Practice Address - Fax:928-776-0208
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 187072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ294372Medicaid
E47755Medicare UPIN
68253Medicare ID - Type Unspecified