Healthcare Provider Details

I. General information

NPI: 1407902166
Provider Name (Legal Business Name): AUDREY PAULY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SIERRA PARK RD
MAMMOTH LAKES CA
93546-0660
US

IV. Provider business mailing address

PO BOX 660 85 SIERRA PARK RD
MAMMOTH LAKES CA
93546-0660
US

V. Phone/Fax

Practice location:
  • Phone: 760-924-4044
  • Fax: 760-924-4125
Mailing address:
  • Phone: 760-924-4044
  • Fax: 760-924-4125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG61957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: