Provider Demographics
NPI:1417952102
Name:AVILES, MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
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 1:627 BIENVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5744
Mailing Address - Country:US
Mailing Address - Phone:318-352-9595
Mailing Address - Fax:318-352-9818
Practice Address - Street 1:627 BIENVILLE CIR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5744
Practice Address - Country:US
Practice Address - Phone:318-352-9595
Practice Address - Fax:318-352-9818
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13467R174400000X
LA13467R MD207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.13467ROtherLA STATE MEDICAL EXAMINERS
LA1679645071OtherCORPORATE NPI #
LA174400000XOtherINDIVIDUAL TAXONOMY#
LA261QM2500XOtherCORPORATE TAXONOMY CODE
LAP01153535OtherMEDICARE RAILROAD PTAN
LA1428809Medicaid
28119OtherCDS#
LADT5115OtherMEDICARE RAILROAD GROUP PTAN#
LADT5115OtherMEDICARE RAILROAD GROUP PTAN#
LAG55114Medicare UPIN
LA1428809Medicaid
LA5H631DF29Medicare PIN