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General NPI Number Information
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NPI Number | 1205599826
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Entity Type | Individual
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Provider Name | ALLAN JOSHUA AVELLANET PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 10/28/2021
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Provider Practice Location Address
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Address Line | 11350 US HIGHWAY 380 STE 100
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City | CROSSROADS
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State | TX
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Zip | 76227-8319
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Country | US
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Telephone | 940-228-0663
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 W PETERS COLONY RD
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City | CARROLLTON
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State | TX
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Zip | 75007-2774
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Country | US
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Telephone | 972-672-8224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA15145
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License Number State | TX
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