Provider Demographics
NPI:1376692079
Name:PENA, RAMIRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMIRO
Middle Name:A
Last Name:PENA
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 1:180 TOWN CENTER BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:JARRELL
Mailing Address - State:TX
Mailing Address - Zip Code:76537-4007
Mailing Address - Country:US
Mailing Address - Phone:512-588-1501
Mailing Address - Fax:512-287-5582
Practice Address - Street 1:180 TOWN CENTER BLVD STE 400
Practice Address - Street 2:
Practice Address - City:JARRELL
Practice Address - State:TX
Practice Address - Zip Code:76537-4007
Practice Address - Country:US
Practice Address - Phone:512-588-1501
Practice Address - Fax:512-287-5582
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1001207Q00000X
TX74-1752692207Q00000X
TX942244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113338102Medicaid
TXD1001OtherMEDICAL LICENSE
TX50EKOtherBCBS OF TEXAS
TX113338102Medicaid