Individual
MARYELLEN GORDIAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
BLDG 60702, FT RICHARDSON, AK 99505
(907) 384-6017
Mailing address
PO BOX 241769, ANCHORAGE, AK 99524-1769
(907) 770-2380
(907) 770-2390
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
2758
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD27581
—
AK
Enumeration date
01/12/2006
Last updated
07/08/2007
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