Provider Demographics
NPI:1598742058
Name:AVILA, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:AVILA
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 1:7887 N KENDALL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7494
Mailing Address - Country:US
Mailing Address - Phone:305-273-6266
Mailing Address - Fax:305-273-6520
Practice Address - Street 1:7887 N KENDALL DR
Practice Address - Street 2:STE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7494
Practice Address - Country:US
Practice Address - Phone:305-273-6266
Practice Address - Fax:305-273-6520
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0054241207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18292OtherBC/BS
FL370855100Medicaid
FL18292OtherBC/BS
FL18292WMedicare ID - Type UnspecifiedMEDICARE