Provider Demographics
NPI:1003824020
Name:BAYLON, PAUL MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MARK
Last Name:BAYLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3118 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-5830
Mailing Address - Country:US
Mailing Address - Phone:323-587-1616
Mailing Address - Fax:323-587-1767
Practice Address - Street 1:3118 E FLORENCE AVE
Practice Address - Street 2:STE #2
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5830
Practice Address - Country:US
Practice Address - Phone:323-587-1616
Practice Address - Fax:323-587-1767
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG48547207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G485470OtherMEDI CAL
CA00G485471Medicaid
E95301Medicare UPIN
CA00G485471Medicaid