Provider Demographics
NPI:1588653455
Name:PENA, JOEL (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOEL
Other - Middle Name:
Other - Last Name:PENA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1207 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4804
Mailing Address - Country:US
Mailing Address - Phone:210-229-9100
Mailing Address - Fax:210-229-9111
Practice Address - Street 1:1207 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4804
Practice Address - Country:US
Practice Address - Phone:210-229-9100
Practice Address - Fax:210-229-9111
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029547901Medicaid
TX00089LMedicare ID - Type Unspecified