MEDICARE: JOEL PENA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	K0538	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588653455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL PENA MD

Provider Business Mailing Address
First Line	:	1207 BROOKLYN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4804
Country	:	US
Telephone Number	:	210-229-9100
Fax Number	:	210-229-9111

Provider Business Practice Location Address
First Line	:	1207 BROOKLYN AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4804
Country	:	US
Telephone Number	:	210-229-9100
Fax Number	:	210-229-9111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	02/26/2019

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