Provider Demographics
NPI:1710918099
Name:PENA, LUIS M (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:M
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4301 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2162
Mailing Address - Country:US
Mailing Address - Phone:863-385-8010
Mailing Address - Fax:863-385-8144
Practice Address - Street 1:4301 SUN N LAKE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2162
Practice Address - Country:US
Practice Address - Phone:863-385-8010
Practice Address - Fax:863-385-8144
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME28625207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD53472Medicare UPIN
FL28069VMedicare ID - Type Unspecified