Provider Demographics
NPI:1215027222
Name:AYALA, VICTOR H (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:H
Last Name:AYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:220 SW 84TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2754
Mailing Address - Country:US
Mailing Address - Phone:954-452-0774
Mailing Address - Fax:954-424-8023
Practice Address - Street 1:220 SW 84TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2754
Practice Address - Country:US
Practice Address - Phone:954-452-0774
Practice Address - Fax:954-424-8023
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 0055215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0402460OtherUNITEDHEALTHCARE PROVIDER
FL100040OtherAVMED PROVIDER NUMBER
FL650219708OtherHUMANA PROVIDER NUMBER
FL09304OtherBCBS PROVIDER NUMBER
FL2011773OtherAETNA PROVIDER NUMBER
FL100040OtherAVMED PROVIDER NUMBER
FL2011773OtherAETNA PROVIDER NUMBER