Provider Demographics
NPI:1356312011
Name:AVILA, PEDRO (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20631 KUYKENDAHL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3318
Mailing Address - Country:US
Mailing Address - Phone:281-453-1001
Mailing Address - Fax:281-803-5515
Practice Address - Street 1:20631 KUYKENDAHL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3318
Practice Address - Country:US
Practice Address - Phone:281-453-1001
Practice Address - Fax:281-803-5515
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036114428207KA0200X
TXQ6305207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ6305OtherTEXAS MEDICAL LICENSE
G65142Medicare UPIN