Healthcare Provider Details

I. General information

NPI: 1376692079
Provider Name (Legal Business Name): RAMIRO A PENA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/24/2022
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TOWN CENTER BLVD STE 400
JARRELL TX
76537-4007
US

IV. Provider business mailing address

180 TOWN CENTER BLVD STE 400
JARRELL TX
76537-4007
US

V. Phone/Fax

Practice location:
  • Phone: 512-588-1501
  • Fax: 512-287-5582
Mailing address:
  • Phone: 512-588-1501
  • Fax: 512-287-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD1001
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number74-1752692
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number942244
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: