1417952102 NPI number — DR. MARTIN AVILES M.D.

Table of content: DR. MARTIN AVILES M.D. (NPI 1417952102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417952102 NPI number — DR. MARTIN AVILES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AVILES
Provider First Name:
MARTIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417952102
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
627 BIENVILLE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NATCHITOCHES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71457-5744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-352-9595
Provider Business Mailing Address Fax Number:
318-352-9818

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
627 BIENVILLE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NATCHITOCHES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71457-5744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-352-9595
Provider Business Practice Location Address Fax Number:
318-352-9818
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  13467R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 13467R MD , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD.13467R . This is a "LA STATE MEDICAL EXAMINERS" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1679645071 . This is a "CORPORATE NPI #" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 174400000X . This is a "INDIVIDUAL TAXONOMY#" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 261QM2500X . This is a "CORPORATE TAXONOMY CODE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: P01153535 . This is a "MEDICARE RAILROAD PTAN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1428809 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 28119 . This is a "CDS#" identifier . This identifiers is of the category "OTHER".
  • Identifier: DT5115 . This is a "MEDICARE RAILROAD GROUP PTAN#" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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