Provider Demographics
NPI:1134176837
Name:AVILA, RAFAEL A (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:AVILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1022 EAST GRIFFIN PARKWAY STE 110
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572
Mailing Address - Country:US
Mailing Address - Phone:956-519-1332
Mailing Address - Fax:956-519-3515
Practice Address - Street 1:1022 E GRIFFIN PKWY STE 110
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2401
Practice Address - Country:US
Practice Address - Phone:956-519-1332
Practice Address - Fax:956-519-3515
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK5785208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG50099Medicare UPIN
TX00918DMedicare ID - Type UnspecifiedMEDICARE PROVIDER