Provider Demographics
NPI:1154664118
Name:AVALOS, DANNY JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:JUAN
Last Name:AVALOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800640
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33280-0640
Mailing Address - Country:US
Mailing Address - Phone:305-974-4822
Mailing Address - Fax:509-420-9737
Practice Address - Street 1:925 NE 30TH TER STE 308
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:305-974-4822
Practice Address - Fax:509-420-9737
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137660207RG0100X, 207R00000X, 207RG0100X, 208D00000X
NMMD2017-0047207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101941600Medicaid
FL740460Medicaid