Individual
COLLIN UDALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3048 E BASELINE RD, STE 109, MESA, AZ 85204-7287
(480) 632-1117
(480) 632-1118
Mailing address
3048 E BASELINE RD, STE 109, MESA, AZ 85204-7286
(480) 632-1117
(480) 632-1118
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15439
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1Z1014
HEALTHNET
AZ
01
—
621104
AETNA INSURANCE
AZ
01
—
AZ0878720
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
05/27/2005
Last updated
09/13/2011
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