Healthcare Provider Details

I. General information

NPI: 1306732912
Provider Name (Legal Business Name): AVMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 IMPERIAL BLVD SUITE 301
SUGAR LAND TX
77498
US

IV. Provider business mailing address

11645 S HIGHWAY 6 # 5010
SUGAR LAND TX
77498-1302
US

V. Phone/Fax

Practice location:
  • Phone: 713-587-6764
  • Fax: 346-521-2175
Mailing address:
  • Phone: 713-587-6764
  • Fax: 346-521-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHISH VALA
Title or Position: OWNER
Credential: MD
Phone: 713-587-6764