Provider Demographics
NPI:1861460297
Name:FORT, MILTON GILES (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:GILES
Last Name:FORT
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 1:500 RUE DE LA VIE ST STE 410
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5128
Mailing Address - Country:US
Mailing Address - Phone:225-216-3006
Mailing Address - Fax:225-216-1081
Practice Address - Street 1:500 RUE DE LA VIE ST STE 410
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5128
Practice Address - Country:US
Practice Address - Phone:225-216-3006
Practice Address - Fax:225-216-1081
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.07008R207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1359556Medicaid
LA1359556Medicaid