Provider Demographics
NPI:1194764225
Name:AVILA, FELIPE MIGUEL (MD)
Entity type:Individual
Prefix:DR
First Name:FELIPE
Middle Name:MIGUEL
Last Name:AVILA
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 1:1408 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6639
Mailing Address - Country:US
Mailing Address - Phone:956-968-0103
Mailing Address - Fax:956-968-0481
Practice Address - Street 1:1408 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6639
Practice Address - Country:US
Practice Address - Phone:956-968-0103
Practice Address - Fax:956-968-0481
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1521208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092547103Medicaid
TX450491147OtherTAX ID NUMBER
TX092547103Medicaid