Provider Demographics
NPI:1275587123
Name:AVILA, JOSE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:AVILA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1380 NE MIAMI GARDENS DR
Mailing Address - Street 2:STE 132
Mailing Address - City:N MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4744
Mailing Address - Country:US
Mailing Address - Phone:305-956-7755
Mailing Address - Fax:305-956-5688
Practice Address - Street 1:1380 NE MIAMI GARDENS DR
Practice Address - Street 2:SUITE 132
Practice Address - City:N MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4707
Practice Address - Country:US
Practice Address - Phone:305-956-7755
Practice Address - Fax:305-956-5688
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2016-07-25
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Provider Licenses
StateLicense IDTaxonomies
FLME77537207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257282600Medicaid
FL46272Medicare PIN
FLH15478Medicare UPIN