Provider Demographics
NPI:1114914843
Name:AVILES, GEORGE MARTINEZ (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:MARTINEZ
Last Name:AVILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5145 W THUNDERBIRD RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4836
Mailing Address - Country:US
Mailing Address - Phone:602-978-5600
Mailing Address - Fax:602-978-6445
Practice Address - Street 1:5145 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4836
Practice Address - Country:US
Practice Address - Phone:602-978-5600
Practice Address - Fax:602-978-6445
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ534041Medicaid
H33089Medicare UPIN
AZ534041Medicaid