Provider Demographics
NPI:1689673139
Name:AYALA, DWIGHT GUIDO (MD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:GUIDO
Last Name:AYALA
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 1:10278 BUENA VENTURA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6766
Mailing Address - Country:US
Mailing Address - Phone:561-368-7055
Mailing Address - Fax:
Practice Address - Street 1:10278 BUENA VENTURA DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-6766
Practice Address - Country:US
Practice Address - Phone:561-368-7055
Practice Address - Fax:561-368-6599
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83667207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263400700Medicaid
FL263400700Medicaid