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1164456943 NPI number — RAUL ADRIAN PENA MD

NPI Number: 1164456943
Health Care Provider/Practitioner: RAUL ADRIAN PENA MD

Information about “1164456943” NPI (RAUL ADRIAN PENA MD) exists in 1164456943 in HTML format HTML  |  1164456943 in plain Text format TXT  |  1164456943 in PDF (Portable Document Format) PDF  |  1164456943 in an XML format XML  formats.

NPI Number : 1164456943 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164456943",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PENA",
    "FirstName": "RAUL",
    "MiddleName": "ADRIAN",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1400 E RIDGE RD STE 10",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MCALLEN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78503-1536",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "956-661-8733",
    "MailingAddressFaxNumber": "956-661-8724",
    "FirstLinePracticeLocationAddress": "1400 E RIDGE RD STE 10",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MCALLEN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78503-1536",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "956-661-8733",
    "PracticeLocationAddressFaxNumber": "956-661-8724",
    "EnumerationDate": "07/10/2006",
    "LastUpdateDate": "05/05/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207W00000X",
        "TaxonomyName": "Ophthalmology Physician",
        "LicenseNumber": "L0504",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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