Provider Demographics
NPI:1154391977
Name:DE LA PENA, JOSE CALIXTO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:CALIXTO
Last Name:DE LA 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 1:4566 NOB HILL DR.
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-5150
Mailing Address - Country:US
Mailing Address - Phone:901-249-7356
Mailing Address - Fax:
Practice Address - Street 1:5722 INTERGRITY DR.
Practice Address - Street 2:BLGD S771 (NBHC MIDSOUTH
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054
Practice Address - Country:US
Practice Address - Phone:901-874-6143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00053436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine