Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JESSE PULLEN PENICO, MD
ActiveDR. JESSE PULLEN PENICO, MD is a Infectious Disease healthcare provider located in GULFPORT, Mississippi. NPI 1912904590 is currently active in the NPPES registry. Verify at CMS.
Infectious Disease · GULFPORT, MS
Registration Details
- NPI Number
- 1912904590
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 28, 2005 (21.139199659787 yrs)
- Last Updated
- Sep 22, 2020
- Licenses
-
ME72349 (FL)015311 (LA)21358 (MS)
Practice Information
- Address
-
1340 BROAD AVESUITE 300GULFPORT, MS, 395012404Browse MS providers · Browse ZIP 39501
- Phone
- 2285752700
- Fax
- 2285752709
- Primary Specialty
-
Infectious Disease
207RI0200X
- Additional Specialty
- Infectious Disease
- Additional Specialty
- Infectious Disease
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.