Provider Demographics
NPI:1568415578
Name:KLAVON, AZIZ A (MD)
Entity Type:Individual
Prefix:
First Name:AZIZ
Middle Name:A
Last Name:KLAVON
Suffix:
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 1:551 HILL COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-6085
Mailing Address - Country:US
Mailing Address - Phone:830-258-7067
Mailing Address - Fax:830-258-7268
Practice Address - Street 1:551 HILL COUNTRY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6085
Practice Address - Country:US
Practice Address - Phone:830-258-7067
Practice Address - Fax:830-258-7268
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118717102Medicaid
TX118717110Medicaid
TX8CB500OtherBC/BS
TX118717108Medicaid
TX118717109Medicaid
TXTXB128076Medicare PIN
TX8CB500OtherBC/BS
TX118717110Medicaid
TXTXB128078Medicare PIN
8L17307Medicare PIN
TX118717108Medicaid