Provider Demographics
NPI:1508128562
Name:AYALA, ABRAHAM G (MD)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:G
Last Name:AYALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1660 S STAPLES ST
Mailing Address - Street 2:STE 150
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-3173
Mailing Address - Country:US
Mailing Address - Phone:361-800-8155
Mailing Address - Fax:361-882-2590
Practice Address - Street 1:1660 S STAPLES ST
Practice Address - Street 2:STE 150
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-3173
Practice Address - Country:US
Practice Address - Phone:361-800-8155
Practice Address - Fax:361-882-2590
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2015-11-17
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Provider Licenses
StateLicense IDTaxonomies
TXQ3324208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
427584YMVUOtherWELLMED NETWORKS INC