Provider Demographics
NPI:1265492730
Name:AVILES, LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
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 1:1007 JEFFORDS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4023
Mailing Address - Country:US
Mailing Address - Phone:727-447-9000
Mailing Address - Fax:727-447-9255
Practice Address - Street 1:1007 JEFFORDS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4023
Practice Address - Country:US
Practice Address - Phone:727-447-9000
Practice Address - Fax:727-447-9255
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 654044207RG0100X
WI82518207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF49046Medicare UPIN
FL25241VMedicare PIN