Provider Demographics
NPI:1215918834
Name:PENA, ANNIE CARTER (MD)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:CARTER
Last Name:PENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNIE
Other - Middle Name:C
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0853
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 570
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-454-2454
Practice Address - Fax:512-454-1532
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4024207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106275401Medicaid
TX89K369OtherBC/BS
TX89K369Medicare PIN