Individual
DR. OCTAVIO A DE LA PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4401 COIT RD, SITE 201, FRISCO, TX 75035-0500
(972) 335-7306
(972) 335-7468
Mailing address
7610 STEMMONS FWY, SUITE 500, DALLAS, TX 75247-4231
(214) 689-5960
(214) 630-7293
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
K3150
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102131303
—
TX
05
—
142704901
—
TX
01
—
8B4310
BCBSTX
TX
Enumeration date
03/20/2006
Last updated
05/26/2010
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