Provider Demographics
NPI:1356656656
Name:M. GILES FORT, M.D. ( A.P.M.C.)
Entity Type:Organization
Organization Name:M. GILES FORT, M.D. ( A.P.M.C.)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:GILES
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-216-3006
Mailing Address - Street 1:9000 AIRLINE HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-4114
Mailing Address - Country:US
Mailing Address - Phone:225-216-3006
Mailing Address - Fax:225-216-1081
Practice Address - Street 1:9000 AIRLINE HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-4114
Practice Address - Country:US
Practice Address - Phone:225-216-3006
Practice Address - Fax:225-216-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1359556Medicaid