Organization
RAYMOND GILLIGAN JR
Active
Other names
Ak prosthetics and orthotics, RAYMOND GILLIGAN JR
Organization subpart
No
Provider details
NPI number
Authorized official
EMILIE H WOODWARD (OFFICE MANAGER)
(907) 455-9255
Entity
Organization
Contact information
Practice address
3517 INDUSTRIAL AVE, FAIRBANKS, AK 99701-7737
(907) 455-9255
(907) 452-1789
Mailing address
3517 INDUSTRIAL AVE, FAIRBANKS, AK 99701-7737
(907) 455-9255
(907) 452-1789
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1110253
BUSINESS LICENCE
AK
Enumeration date
03/04/2019
Last updated
07/05/2021
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