Provider Demographics
NPI:1932461696
Name:AVILA, TAWNY E (DO)
Entity Type:Individual
Prefix:DR
First Name:TAWNY
Middle Name:E
Last Name:AVILA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TAWNY
Other - Middle Name:E
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5315 E HIGH ST UNIT 308A
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5441
Mailing Address - Country:US
Mailing Address - Phone:314-687-0063
Mailing Address - Fax:
Practice Address - Street 1:901 LINCOLNWAY
Practice Address - Street 2:C/O NOEMI RODGERS
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350
Practice Address - Country:US
Practice Address - Phone:219-326-2461
Practice Address - Fax:219-326-2584
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012011166207Q00000X
IN02004742A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine