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Organization

DENALI CARDIAC AND THORACIC SURGICAL GROUP LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KENTON EDGAR STEPHENS JR. MD (PHYSICIAN / OWNER)
(907) 375-2000
Entity
Organization

Contact information

Practice address
2751 DEBARR RD STE B320, ANCHORAGE, AK 99508-6805
(907) 375-2000
(907) 375-5558
Mailing address
PO BOX 3482, POST FALLS, ID 83877-3482
(208) 209-6170
(208) 209-6169

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
K152964
MEDICARE ID
AK
Enumeration date
07/15/2006
Last updated
09/28/2020
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