Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 17893 | AL |
NPI | 1003994948 |
---|---|
Provider Name | Mr. Victor E Pena |
First Address | Montgomery, AL 36117-7005 |
Second Address | Montgomery, AL 36117-4336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009932478 | (05) | AL |
051529494 | BCBS (01) | AL |
102I168904 | MEDICARE (01) | AL |
200812 | (05) | AL |
200815 | (05) | AL |
202136 | (05) | AL |
440440 | CIGNA (01) | |
511-93871 | BCBS OF ALABAMA (01) | AL |
511-93875 | BCBS OF ALABAMA (01) | AL |
511-93901 | BCBS OF ALABAMA (01) | AL |
A82388 | (02) | |
A82388 | VIVA HEALTH (01) | |
P01873134 | RR MEDICARE (01) |