MEDICARE: MIGUEL ANGEL AYALA 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	K4628	TX

General Provider Information

NPI Number	:	1174510507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIGUEL ANGEL AYALA MD

Provider Business Mailing Address
First Line	:	600 DIVISION AVE STE E
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-1336
Country	:	US
Telephone Number	:	210-222-0333
Fax Number	:	762-268-7701

Provider Business Practice Location Address
First Line	:	600 DIVISION AVE STE E
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-1336
Country	:	US
Telephone Number	:	210-222-0333
Fax Number	:	762-268-7701

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	03/16/2023

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