Provider Demographics
NPI:1821399536
Name:WILBUR S. AVANT, JR.,M.D.,P.A.
Entity Type:Organization
Organization Name:WILBUR S. AVANT, JR.,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:S
Authorized Official - Last Name:AVANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-614-3581
Mailing Address - Street 1:7711 LOUIS PASTEUR DR.
Mailing Address - Street 2:SUITE 810
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3423
Mailing Address - Country:US
Mailing Address - Phone:210-614-3581
Mailing Address - Fax:210-614-3584
Practice Address - Street 1:7711 LOUIS PASTEUR DR.
Practice Address - Street 2:SUITE 810
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3423
Practice Address - Country:US
Practice Address - Phone:210-614-3581
Practice Address - Fax:210-614-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE21302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21013Medicare UPIN