Healthcare Provider Details

I. General information

NPI: 1114251352
Provider Name (Legal Business Name): LOUIS D'AVIGNON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MADISON OAK SUITE 560
SAN ANTONIO TX
78258-3943
US

IV. Provider business mailing address

1501 NE MEDICAL CENTER DR
BEND OR
97701-6051
US

V. Phone/Fax

Practice location:
  • Phone: 210-525-1668
  • Fax: 210-525-1669
Mailing address:
  • Phone: 541-382-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM3508
License Number StateTX

VIII. Authorized Official

Name: LOUIS M D'AVIGNON
Title or Position: OWNER
Credential: MD
Phone: 210-494-4220