Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | N7650 | TX |
NPI | 1003922964 |
---|---|
Provider Name | Enrique B Pena |
First Address | Austin, TX 78701-1926 |
Second Address | Austin, TX 78731-6400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 11/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
219476302 | (05) | TX |