Provider Demographics
NPI:1073726360
Name:AVALON CLINIC
Entity Type:Organization
Organization Name:AVALON CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLASTIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFLIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-582-8486
Mailing Address - Street 1:9315 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1574
Mailing Address - Country:US
Mailing Address - Phone:253-582-8486
Mailing Address - Fax:253-582-2644
Practice Address - Street 1:9315 GRAVELLY LAKE DR SW
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-1574
Practice Address - Country:US
Practice Address - Phone:253-582-8486
Practice Address - Fax:253-582-2644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046009261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center