Organization
AVALON OBSTETRICS AND GYNECOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM SNIDER (OFFICE MANAGER)
(573) 701-9600
Entity
Organization
Contact information
Practice address
1105 W LIBERTY ST, SUITE 2050, FARMINGTON, MO 63640-1921
(573) 701-9600
(573) 701-9605
Mailing address
1105 W LIBERTY ST, SUITE 2050, FARMINGTON, MO 63640-1921
(573) 701-9600
(573) 701-9605
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
R9B54
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
241676840
—
MO
01
—
DD7351
RAILROAD MEDICARE
MO
Enumeration date
10/20/2006
Last updated
01/21/2010
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