Individual
DR. JOSE RAUL PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9604 HOLLY POINT DR, HUNTERSVILLE, NC 28078-4913
(704) 316-5070
(704) 316-5075
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-5070
(704) 316-5075
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
009000253
NC
207N00000X
Dermatology Physician
Primary
26801
NC
207ZD0900X
Dermatopathology (Pathology) Physician
009000253
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218605
—
NC
05
—
5900708
—
NC
Enumeration date
12/21/2005
Last updated
10/25/2020
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