Individual
DR. LEONIDAS PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 NORTH PARK ST, BRENHAM, TX 77833-2610
(979) 836-6153
Mailing address
600 NORTH PARK ST, BRENHAM, TX 77833-2610
(979) 836-6153
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
J1755
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
041211602
—
TX
01
—
10006449
AMERIGROUP
TX
01
—
111268
SUPERIOR CHIPS
TX
Enumeration date
05/23/2005
Last updated
04/27/2012
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