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Organization

EAGLE RIVER PRIMARY CARE

Active
Other names
Eagle River Primary Care, LLC
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIFER J OXFORD PA-C (REGISTERED AGENT)
(907) 694-0770
Entity
Organization

Contact information

Practice address
11462 BUSINESS BLVD, EAGLE RIVER, AK 99577-7721
(907) 694-0770
(907) 694-1378
Mailing address
11462 BUSINESS BLVD, EAGLE RIVER, AK 99577-7721
(907) 694-0770
(907) 694-1378

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA448
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
$$$$$$$$$
INDIVIDUAL SSN
AK
01
1326187055
INDIVIDUAL NPI
AK
01
1407920085
INDIVIDUAL NPI
AK
05
MD42453
AK
05
MD57671
AK
Enumeration date
11/05/2007
Last updated
05/21/2020
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