Individual
DR. MICHAEL R PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D. PHD
Contact information
Practice address
1600 N MAIN AVE, LOVINGTON, NM 88260-2830
(575) 396-6611
(575) 396-4547
Mailing address
1600 N MAIN AVE, LOVINGTON, NM 88260-2830
(575) 396-6611
(575) 396-4547
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
26460
NE
207Q00000X
Family Medicine Physician
8607
SD
207Q00000X
Family Medicine Physician
Primary
MD2017-0882
NM
207Q00000X
Family Medicine Physician
MD443240
PA
Other
Enumeration date
04/07/2011
Last updated
03/17/2018
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