Healthcare Provider Details

I. General information

NPI: 1609930676
Provider Name (Legal Business Name): BAYWOOD MEDICAL ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6309 E BAYWOOD AVE
MESA AZ
85206-1744
US

IV. Provider business mailing address

PO BOX 13550
MESA AZ
85216-3550
US

V. Phone/Fax

Practice location:
  • Phone: 480-325-3801
  • Fax: 480-325-3805
Mailing address:
  • Phone: 480-325-3801
  • Fax: 480-325-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberOSC-3134
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC BOYD
Title or Position: PHYSICIAN-PARTNER/OWNER
Credential: MD
Phone: 480-325-3801