Provider Demographics
NPI:1407091580
Name:ANTONIO PENA MD P.A.
Entity Type:Organization
Organization Name:ANTONIO PENA MD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-569-0400
Mailing Address - Street 1:1329 N UNIVERSITY DR
Mailing Address - Street 2:SUITE E-5
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961-4232
Mailing Address - Country:US
Mailing Address - Phone:936-569-0400
Mailing Address - Fax:936-569-0530
Practice Address - Street 1:1329 N UNIVERSITY DR
Practice Address - Street 2:SUITE E-5
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4232
Practice Address - Country:US
Practice Address - Phone:936-569-0400
Practice Address - Fax:936-569-0530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty