MEDICARE: INSTITUTE OF PLASTIC SURGERY IN SAN ANTONIO, PA

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	174400000X	Specialist	J1851	TX

General Provider Information

NPI Number	:	1386803765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE OF PLASTIC SURGERY IN SAN ANTONIO, PA

Provider Business Mailing Address
First Line	:	4499 MEDICAL DRIVE
Second Line	:	SUITE 301
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229
Country	:	US
Telephone Number	:	210-692-3223
Fax Number	:

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DRIVE
Second Line	:	SUITE 301
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3713
Country	:	US
Telephone Number	:	210-692-3223
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JOHN ANTHONY AYALA
Credential	:	M.D.
Telephone Number	:	210-692-3223

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	10/22/2009

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