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General NPI Number Information
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NPI Number | 1679645071
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Entity Type | Organization
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Legal Business Name | MARTIN AVILES MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 627 BIENVILLE CIR
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City | NATCHITOCHES
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State | LA
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Zip | 71457-5744
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Country | US
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Telephone | 318-352-9595
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Fax | 318-352-9818
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Provider Business Mailing Address
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Address Line | 627 BIENVILLE CIR
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City | NATCHITOCHES
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State | LA
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Zip | 71457-5744
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Country | US
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Telephone | 318-352-9595
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Fax | 318-352-9818
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. MARTIN AVILES
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Credential | MD
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Telephone | 318-352-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 13567R
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License Number State | LA
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