Individual
DR. FAUSTO AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2010 E VILLA MARIA RD # A, BRYAN, TX 77802-2540
(979) 776-7513
(940) 592-4842
Mailing address
2010 E VILLA MARIA RD # A, BRYAN, TX 77802-2540
(979) 776-7513
(940) 592-4842
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
K3071
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105087403
—
TX
01
—
8U5907
BLUE CROSS BLUE SHIELD
TX
01
—
P00449161
MEDICARE RAILROAD
—
Enumeration date
09/11/2006
Last updated
06/19/2008
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