# H PENA MD NORTH MAIN MEDICAL AND SURGICAL CLINIC ASSOC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477607240
- **Authorized official:** HERIBERTO PENA MD (PRESIDENT)
- **Authorized official phone:** (817) 625-2791

## Contact information

- **Practice address:** 3301 NORTH MAIN STREET, FORT WORTH, TX 76106
- **Practice address phone:** (817) 625-2791
- **Practice address fax:** (817) 740-1550
- **Mailing address:** 3301 NORTH MAIN STREET, FORT WORTH, TX 76106
- **Mailing address phone:** (817) 625-2791
- **Mailing address fax:** (817) 740-1550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | C7083 | TX | Yes |

## Other

- **Enumeration date:** 01/22/2007
- **Last updated:** 08/22/2020