Provider Demographics
NPI:1871686360
Name:INOCENCIO A. DAVILA, M.D.,P.A.
Entity Type:Organization
Organization Name:INOCENCIO A. DAVILA, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INOCENCIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-481-9252
Mailing Address - Street 1:P.O. BOX 591459
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259
Mailing Address - Country:US
Mailing Address - Phone:210-227-5168
Mailing Address - Fax:210-224-6945
Practice Address - Street 1:621 N. ALAMO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215
Practice Address - Country:US
Practice Address - Phone:210-481-9252
Practice Address - Fax:210-481-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4955207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QC44Medicare ID - Type UnspecifiedTRAILBLAZER
TXB22139Medicare UPIN