Penico, Jesse Pullen

Penico, Jesse Pullen is an individual health care provider with primary practice located at 1340 Broad Ave Suite 300, Gulfport MS 39501-2404. He recently has only one registered license in Allopathic & Osteopathic Physicians / Infectious Disease, which is considered as his primary health care specialty. Penico, Jesse Pullen can be contacted via phone (228) 575-2700.

Contact Information

Primary practice address
1340 Broad Ave Suite 300 Gulfport MS 39501-2404
Phone: (228) 575-2700
Fax: (228) 575-2709
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Infectious Disease 207RI0200X ME72349 Florida
Allopathic & Osteopathic Physicians / Infectious Disease 207RI0200X 015311 Louisiana
Allopathic & Osteopathic Physicians / Infectious Disease 207RI0200X 21358 Mississippi

Profile Details

NPI number 1912904590
LBN Legal business name Penico, Jesse Pullen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2005
Last updated Sep 22nd, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912904590 NPPES
Mississippi MEDICAID 00112089
Mississippi MEDICAID 1339181

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