Provider Demographics
NPI:1215971882
Name:AYOUB, VIVIAN M (MD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:M
Last Name:AYOUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:M
Other - Last Name:HABIB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 NAVARRO ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2900
Mailing Address - Country:US
Mailing Address - Phone:210-354-0800
Mailing Address - Fax:210-598-7876
Practice Address - Street 1:18414 US HIGHWAY 281 N
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-7610
Practice Address - Country:US
Practice Address - Phone:210-354-0800
Practice Address - Fax:210-598-7876
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H97070Medicare UPIN
TXTXB119352Medicare PIN