Provider Demographics
NPI:1598087108
Name:ROBERTO M. PENA, MD PA
Entity Type:Organization
Organization Name:ROBERTO M. PENA, MD PA
Other - Org Name:AUSTIN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:MATTA
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-477-4693
Mailing Address - Street 1:2911 MEDICAL ARTS ST
Mailing Address - Street 2:BUILDING #14
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3376
Mailing Address - Country:US
Mailing Address - Phone:512-477-4693
Mailing Address - Fax:512-477-2160
Practice Address - Street 1:2911 MEDICAL ARTS ST
Practice Address - Street 2:BUILDING #14
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3376
Practice Address - Country:US
Practice Address - Phone:512-477-4693
Practice Address - Fax:512-477-2160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3051207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1366451759OtherNPI
TX1366451759OtherNPI