Avalon Surgical PC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Legal business name

AVALON SURGICAL PC

Practice address

700 Colorado Blvd
Ste 115
Denver, CO 80206-4084

Phone

(281) 324-5660

NPI assigned

Mar 23, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Fred J Diss

Title

Registered Agent

Phone

(281) 324-5660

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427068800000",
    "number": "1962896563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1288",
            "city": "CROSBY",
            "state": "TX",
            "postal_code": "775321288",
            "telephone_number": "281-324-5660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 COLORADO BLVD",
            "address_2": "STE 115",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802064084",
            "telephone_number": "281-324-5660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON SURGICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-23",
        "last_updated": "2015-03-23",
        "status": "A",
        "authorized_official_last_name": "DISS",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "REGISTERED AGENT",
        "authorized_official_telephone_number": "281-324-5660"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Denver, CO
• Providers in Denver, CO by specialty
• Surgical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.