Provider Demographics
NPI:1548346323
Name:RICHARD C. PENA, M.D., P.A.
Entity type:Organization
Organization Name:RICHARD C. PENA, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-767-5581
Mailing Address - Street 1:1607 BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5619
Mailing Address - Country:US
Mailing Address - Phone:940-767-5581
Mailing Address - Fax:940-767-0046
Practice Address - Street 1:1607 BROOK AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5619
Practice Address - Country:US
Practice Address - Phone:940-767-5581
Practice Address - Fax:940-767-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1895207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN4511OtherRAILROAD MEDICARE
TX1828790-01Medicaid
TX1828790-01Medicaid
TXA02188Medicare UPIN