Organization
SRA D.O. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SPENCER RICHARD AUGUSTIN DO (PRESIDENT)
(907) 529-0103
Entity
Organization
Contact information
Practice address
2530 DEBARR RD, ANCHORAGE, AK 99508-2948
(907) 258-7575
(907) 561-7464
Mailing address
PO BOX 241889, ANCHORAGE, AK 99524-1889
(907) 563-1777
(907) 561-7464
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730694
—
AK
Enumeration date
04/26/2022
Last updated
08/23/2022
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