Organization
AVALON BIOTECHNICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARC A BAUDER MD (OWNER)
(928) 368-8200
Entity
Organization
Contact information
Practice address
3364 KAY RD, LAKESIDE, AZ 85929-5405
(928) 368-8200
(928) 368-8208
Mailing address
PO BOX 1912, SHOW LOW, AZ 85902-1912
(928) 368-8200
(928) 368-8208
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
15235
AZ
Other
Enumeration date
03/21/2007
Last updated
11/26/2008
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