Individual
DEOGRACIAS R PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 E PRINCETON ST, SUITE 401, ORLANDO, FL 32803-1456
(407) 303-9311
(407) 303-9273
Mailing address
615 E PRINCETON ST, SUITE 401, ORLANDO, FL 32803-1456
(407) 303-9311
(407) 303-9273
Taxonomy
Speciality
Code
Description
License number
State
2080P0210X
Pediatric Nephrology Physician
J9778
TX
2080P0210X
Pediatric Nephrology Physician
Primary
ME56326
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00U87Z
BCBSTX GRP PIN
TX
01
—
10010075
AMERIGROUP PIN
TX
01
—
109517
SUPERIOR PIN
TX
01
—
121266102
FIRSTCARE PIN
TX
05
—
133426012
—
TX
01
—
1443501
UHC PIN
TX
01
—
1750369203
GRP NPI NUMBER
—
01
—
5056081
AETNA PIN
TX
01
—
75208965
CIGNA PIN
TX
01
—
87Y112
BCBSTX PIN
TX
Enumeration date
08/11/2006
Last updated
09/06/2014
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