Healthcare Provider Details

I. General information

NPI: 1477976660
Provider Name (Legal Business Name): DAVID ERNESTO AVILES MARTINEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 PRESTON RD STE 300
PLANO TX
75024-3236
US

IV. Provider business mailing address

122 W JOHN CARPENTER FWY STE 420
IRVING TX
75039-2014
US

V. Phone/Fax

Practice location:
  • Phone: 972-608-3800
  • Fax: 972-608-3810
Mailing address:
  • Phone: 972-957-3000
  • Fax: 972-957-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28687
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT4114
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: