Provider Demographics
NPI:1386607596
Name:FIALA, LOIS A (MD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:A
Last Name:FIALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 LEXINGTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4790
Mailing Address - Country:US
Mailing Address - Phone:210-420-8671
Mailing Address - Fax:210-899-1958
Practice Address - Street 1:718 LEXINGTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4790
Practice Address - Country:US
Practice Address - Phone:210-420-8671
Practice Address - Fax:210-899-1958
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2885208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151736903Medicaid
P00965851OtherMEDICARE RAILROAD
TX151736903Medicaid
P00965851OtherMEDICARE RAILROAD
TX8FB837OtherBCBSTX - PVA
TXP01465881OtherMEDICARE RR - PVA
TXP01465881OtherMEDICARE RR - PVA
P00965851OtherMEDICARE RAILROAD
TXTXB126523Medicare PIN