Provider Demographics
NPI:1932575206
Name:AYMOND, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:AYMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 HENNESSY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4375
Mailing Address - Country:US
Mailing Address - Phone:225-926-6565
Mailing Address - Fax:
Practice Address - Street 1:7777 HENNESSY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4363
Practice Address - Country:US
Practice Address - Phone:225-765-2048
Practice Address - Fax:225-765-9100
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA048015OtherSTATE NARCOTICS LICENSE
LA200889OtherSTATE LICENSE
LA2409611Medicaid
LAMA3875169OtherDEA