Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | N2728 | TX |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | N2728 | TX |
NPI | 1750559902 |
---|---|
Provider Name | Dr. Rene Mario Pena JR. |
First Address | Arlington, TX 76014-2069 |
Second Address | Arlington, TX 76014-2069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2008 |
Last Update Date | 01/10/2013 |