Provider Demographics
NPI:1962443911
Name:HAROLD J. PEAN MD
Entity Type:Organization
Organization Name:HAROLD J. PEAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-519-0770
Mailing Address - Street 1:PO BOX 1708
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0030
Mailing Address - Country:US
Mailing Address - Phone:956-519-0770
Mailing Address - Fax:956-519-0718
Practice Address - Street 1:909 BUSINESS PARK
Practice Address - Street 2:STE 6
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6052
Practice Address - Country:US
Practice Address - Phone:956-519-0770
Practice Address - Fax:956-519-0718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
J3185207R00000X
K2290207R00000X
TXH2104207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F17663Medicare UPIN
0061AZMedicare PIN