Provider Demographics
NPI:1003994948
Name:PENA, VICTOR E (MD)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:E
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:301 BROWN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7005
Mailing Address - Country:US
Mailing Address - Phone:334-747-4159
Mailing Address - Fax:
Practice Address - Street 1:2455 BELL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4336
Practice Address - Country:US
Practice Address - Phone:334-747-8970
Practice Address - Fax:334-747-8980
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17893207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200815Medicaid
AL511-93901OtherBCBS OF ALABAMA
AL511-93875OtherBCBS OF ALABAMA
AL102I168904OtherMEDICARE
440440OtherCIGNA
AL511-93871OtherBCBS OF ALABAMA
AL009932478Medicaid
AL202136Medicaid
P01873134OtherRR MEDICARE
AL051529494OtherBCBS
AL200812Medicaid
A82388OtherVIVA HEALTH
A82388OtherVIVA HEALTH