Healthcare Provider Details

I. General information

NPI: 1528668720
Provider Name (Legal Business Name): ANTENOR XAVIER AVILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 E MCDOWELL RD
PHOENIX AZ
85008-4504
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 602-858-4295
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35191R
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME154019
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number65267
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME154019
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number65267
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: