Provider Demographics
NPI:1760471866
Name:PENA, ALEJANDRO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:J
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 522468
Mailing Address - Street 2:PHYSICIAN ASSOCIATES LLC
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32752-2468
Mailing Address - Country:US
Mailing Address - Phone:407-804-5379
Mailing Address - Fax:407-804-5398
Practice Address - Street 1:7472 DOCS GROVE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8010
Practice Address - Country:US
Practice Address - Phone:407-381-7336
Practice Address - Fax:407-351-6872
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME62007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375210100Medicaid
FL375210100Medicaid
F87015Medicare UPIN