Provider Demographics
NPI:1538512082
Name:VILLAR AYALA, WALTER EDISON (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:EDISON
Last Name:VILLAR AYALA
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 1:1102 BATES AVE
Mailing Address - Street 2:SUITE 245
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2617
Mailing Address - Country:US
Mailing Address - Phone:832-824-3800
Mailing Address - Fax:832-825-9330
Practice Address - Street 1:1102 BATES AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2617
Practice Address - Country:US
Practice Address - Phone:832-824-3800
Practice Address - Fax:832-825-9330
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10057766390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program