Provider Demographics
NPI:1538158050
Name:AVILA, FERNANDO T III (MD)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:T
Last Name:AVILA
Suffix:III
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 1:231 WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1336
Mailing Address - Country:US
Mailing Address - Phone:210-226-0029
Mailing Address - Fax:
Practice Address - Street 1:700 S SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-3435
Practice Address - Country:US
Practice Address - Phone:210-223-1181
Practice Address - Fax:210-226-1268
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2899207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742548575OtherANESTHESIA PRACTICE
TX126164601Medicaid
TX742609895OtherPAIN MANAGEMENT PRACTICE
TX00D23KMedicare ID - Type Unspecified
TX126164601Medicaid