Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME91213 | FL |
N | 111NI0900X | Internist | ME91213 | FL |
Y | 207RH0000X | Hematologist | ME91213 | FL |
N | 207RH0003X | Hematology & Oncology | ME91213 | FL |
NPI | 1336164342 |
---|---|
Provider Name | Dr. Ernesto Ayala |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
270719500 | (05) | FL |
50006 | BLUE CROSS BLUE SHIELD (01) | FL |
50006X | MEDICARE PTAN (01) | FL |
I19093 | (02) | FL |