Provider Demographics
NPI:1285744029
Name:ARVELLO, ANTHONY ALAN (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:ALAN
Last Name:ARVELLO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:806-351-7070
Mailing Address - Fax:
Practice Address - Street 1:1000 CRAIG DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4015
Practice Address - Country:US
Practice Address - Phone:806-331-7905
Practice Address - Fax:806-731-1516
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02103363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841991-04Medicaid
TX8888NKOtherBCBS
1037608OtherNCCPA CERTIFICATION NUMBER
TX970030289OtherMEDICARE RAILROAD NUMBER
TXPA - 02103OtherSTATE LICENSE NUMBER
P66012Medicare UPIN
84P255Medicare ID - Type Unspecified
TX1841991-04Medicaid