Provider Demographics
NPI:1578508123
Name:BAYONA, JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:BAYONA
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 1:825 E RUNDBERG LN STE B1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4860
Mailing Address - Country:US
Mailing Address - Phone:512-978-9600
Mailing Address - Fax:512-978-9601
Practice Address - Street 1:825 E RUNDBERG LN STE B1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4860
Practice Address - Country:US
Practice Address - Phone:512-978-9600
Practice Address - Fax:512-978-9601
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE17926Medicare UPIN
TX86651JMedicare PIN
TXE17926Medicare UPIN
TX044944901Medicaid
TX080150593Medicare PIN