Provider Demographics
NPI:1477742740
Name:DUBY AVILA M.D. P.A.
Entity Type:Organization
Organization Name:DUBY AVILA M.D. P.A.
Other - Org Name:OSCEOLA PAIN AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUBY
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-846-6040
Mailing Address - Street 1:1111 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4405
Mailing Address - Country:US
Mailing Address - Phone:407-846-6040
Mailing Address - Fax:407-846-9540
Practice Address - Street 1:1111 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4405
Practice Address - Country:US
Practice Address - Phone:407-846-6040
Practice Address - Fax:407-846-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267601000Medicaid
FLH70138Medicare UPIN
FL267601000Medicaid