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Individual

MICHAEL J ROYLANCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1717 WEST COWLES STREET, FAIRBANKS, AK 99701
(907) 378-1997
(907) 458-3811
Mailing address
1717 WEST COWLES STREET, FAIRBANKS, AK 99701
(907) 378-1997
(907) 458-3811

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
835
AK
363A00000X
Physician Assistant
PAD T 2002
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AK 835
MEDICAL LICENSE
AK
05
MDA0289
AK
Enumeration date
12/23/2008
Last updated
12/04/2012
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