Provider Demographics
NPI:1245567593
Name:PABLO AYUB MD PA
Entity Type:Organization
Organization Name:PABLO AYUB MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:AYUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-772-5849
Mailing Address - Street 1:5301 ALAMEDA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2805
Mailing Address - Country:US
Mailing Address - Phone:915-772-5849
Mailing Address - Fax:915-772-6226
Practice Address - Street 1:5301 ALAMEDA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2805
Practice Address - Country:US
Practice Address - Phone:915-772-5849
Practice Address - Fax:915-772-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC1579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21037Medicare UPIN