Provider Demographics
NPI:1164456943
Name:PENA, RAUL ADRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ADRIAN
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 E RIDGE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1536
Mailing Address - Country:US
Mailing Address - Phone:956-661-8733
Mailing Address - Fax:956-661-8724
Practice Address - Street 1:1400 E RIDGE RD STE 10
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1536
Practice Address - Country:US
Practice Address - Phone:956-661-8733
Practice Address - Fax:956-661-8724
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0504207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL0504OtherMEDICAL LICENSE
TXH23344Medicare UPIN