# FAMILY MEDICAL CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Lavern Davidhizar
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073701421
- **Authorized official:** DR. LAVERN R DAVIDHIZAR DO (PRESIDENT)
- **Authorized official phone:** (907) 262-7566

## Contact information

- **Practice address:** 206 W ROCKWELL AVE, SUITE 100, SOLDOTNA, AK 99669-7411
- **Practice address phone:** (907) 262-7566
- **Practice address fax:** (907) 262-0809
- **Mailing address:** 206 W ROCKWELL AVE, SUITE 100, SOLDOTNA, AK 99669-7411
- **Mailing address phone:** (907) 262-7566
- **Mailing address fax:** (907) 262-0809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 4221 | AK | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 4221 | AK | — |
| 207Q00000X | Family Medicine Physician | 1454 | AK | Yes |

## Other

- **Enumeration date:** 10/11/2007
- **Last updated:** 10/29/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | MD1454 | — | AK |