MEDICARE: REUBEN WILLIAM AVILA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD13140	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	110001727	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0020052	OTHER		BLUE CROSS

General Provider Information

NPI Number	:	1073621827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REUBEN WILLIAM AVILA MD

Provider Business Mailing Address
First Line	:	6799 GREAT OAKS RD
Second Line	:	SUITE 250
City	:	MEMPHIS
State	:	TN
Zip	:	38138-2588
Country	:	US
Telephone Number	:	901-821-8300
Fax Number	:	901-261-0701

Provider Business Practice Location Address
First Line	:	6799 GREAT OAKS RD
Second Line	:	SUITE 250
City	:	MEMPHIS
State	:	TN
Zip	:	38138-2588
Country	:	US
Telephone Number	:	901-821-8300
Fax Number	:	901-261-0701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/20/2010

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Directions to “ REUBEN WILLIAM AVILA MD” Practice Location

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