Provider Demographics
NPI:1386617041
Name:PENA, JAIME (MD)
Entity type:Individual
Prefix:MR
First Name:JAIME
Middle Name:
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7121 SPID
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412
Mailing Address - Country:US
Mailing Address - Phone:361-851-5000
Mailing Address - Fax:361-851-0590
Practice Address - Street 1:7121 SPID
Practice Address - Street 2:SUITE 302
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412
Practice Address - Country:US
Practice Address - Phone:361-851-5000
Practice Address - Fax:361-851-0590
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5471207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115238101Medicaid
C20373Medicare UPIN
TX115238101Medicaid