Provider Demographics
NPI:1326062969
Name:AVARA, WILLIAM TRAVIS III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TRAVIS
Last Name:AVARA
Suffix:III
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 1:2525 TELEPHONE RD
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567
Mailing Address - Country:US
Mailing Address - Phone:228-762-4483
Mailing Address - Fax:228-769-0406
Practice Address - Street 1:2525 TELEPHONE RD
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567
Practice Address - Country:US
Practice Address - Phone:228-762-4483
Practice Address - Fax:228-769-0406
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09935208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00115538Medicaid
MSD20018482OtherRAILROAD MEDICARE
B66090Medicare UPIN
MSD20018482OtherRAILROAD MEDICARE