Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | Q6305 | TX |
N | 207KA0200X | Allergist | 036114428 | IL |
NPI | 1356312011 |
---|---|
Provider Name | Pedro Avila |
First Address | Spring, TX 77379-3318 |
Second Address | Spring, TX 77379-3318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 22/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G65142 | (02) | |
Q6305 | TEXAS MEDICAL LICENSE (01) | TX |