Organization
COTTONWOOD CREEK CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD BLAKE (OWNER)
(907) 373-5950
Entity
Organization
Contact information
Practice address
3600 E WICKERSHAM WAY, WASILLA, AK 99654-7550
(907) 373-5950
(907) 373-5954
Mailing address
3600 E WICKERSHAM WAY, WASILLA, AK 99654-7550
(907) 373-5950
(907) 373-5954
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1011473
AK
Other
Enumeration date
10/09/2014
Last updated
03/07/2023
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