Provider Demographics
NPI:1922111251
Name:AUVIL, DALLAS G (MD)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:G
Last Name:AUVIL
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 1:4685 FOREST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3359
Mailing Address - Country:US
Mailing Address - Phone:513-862-2692
Mailing Address - Fax:513-862-1584
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINTI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-2692
Practice Address - Fax:513-862-1584
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350541422084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000020581OtherANTHEM
195110000OtherMAGELLAN
6409372700OtherKENTUCKY MEDICAID
200290120AOtherINDIANA MEDICAID
260043102OtherRAILROAD MEDICARE
31153618600OtherBWC
OH0158645Medicaid
31153618600OtherBWC
31153618600OtherBWC