Provider Demographics
NPI:1487699856
Name:AVONDET, ALAN G (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:G
Last Name:AVONDET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S WOODRUFF AVE
Mailing Address - Street 2:SUITE #15
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6374
Mailing Address - Country:US
Mailing Address - Phone:208-522-7310
Mailing Address - Fax:208-524-0559
Practice Address - Street 1:2001 S WOODRUFF AVE
Practice Address - Street 2:SUITE #15
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6374
Practice Address - Country:US
Practice Address - Phone:208-522-7310
Practice Address - Fax:208-524-0559
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010003854OtherREGENCE BLUE SHIELD
IDMD3207OtherIDAHO STATE NARC. #
ID4469-3OtherBLUE CROSS
ID4469-3OtherBLUE CROSS
ID4469-3OtherBLUE CROSS
IDD93300Medicare UPIN