MEDICARE: DR. CARLOS AYALA M.D.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	208769	MA
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	P4845	TX

General Provider Information

NPI Number	:	1881688174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS AYALA M.D.

Provider Business Mailing Address
First Line	:	800 E DOVE AVE
Second Line	:	STE F & G
City	:	MCALLEN
State	:	TX
Zip	:	78504-2262
Country	:	US
Telephone Number	:	956-631-4515
Fax Number	:	956-627-6071

Provider Business Practice Location Address
First Line	:	800 E DOVE AVE
Second Line	:	STE F AND G
City	:	MCALLEN
State	:	TX
Zip	:	78504-2262
Country	:	US
Telephone Number	:	956-631-4515
Fax Number	:	956-661-8205

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	04/21/2015

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