MEDICARE: DR. DWIGHT GUIDO 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	207Q00000X	Family Medicine Physician	ME83667	FL
2	208M00000X	Hospitalist Physician	ME83667	FL

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

General Provider Information

NPI Number	:	1689673139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWIGHT GUIDO AYALA MD

Provider Business Mailing Address
First Line	:	10278 BUENA VENTURA DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-6766
Country	:	US
Telephone Number	:	561-368-7055
Fax Number	:

Provider Business Practice Location Address
First Line	:	10278 BUENA VENTURA DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33498-6766
Country	:	US
Telephone Number	:	561-368-7055
Fax Number	:	561-368-6599

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/08/2016

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