Provider Demographics
NPI:1609873512
Name:PEAN, JOSEPH LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LESLIE
Last Name:PEAN
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 1:1604 E 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-5587
Mailing Address - Country:US
Mailing Address - Phone:956-793-2835
Mailing Address - Fax:956-447-5747
Practice Address - Street 1:1604 E 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-5587
Practice Address - Country:US
Practice Address - Phone:956-447-5557
Practice Address - Fax:956-447-5747
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5602207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128196606Medicaid
TX128196606Medicaid