Organization
FAMILY MEDICAL CLINIC
Active
Other names
Lavern Davidhizar
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAVERN R DAVIDHIZAR DO (PRESIDENT)
(907) 262-7566
Entity
Organization
Contact information
Practice address
206 W ROCKWELL AVE, SUITE 100, SOLDOTNA, AK 99669-7411
(907) 262-7566
(907) 262-0809
Mailing address
206 W ROCKWELL AVE, SUITE 100, SOLDOTNA, AK 99669-7411
(907) 262-7566
(907) 262-0809
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4221
AK
207LP2900X
Pain Medicine (Anesthesiology) Physician
4221
AK
207Q00000X
Family Medicine Physician
Primary
1454
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD1454
—
AK
Enumeration date
10/11/2007
Last updated
10/29/2012
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