Individual
MR. MATTHEW WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 TOKSOOK BAY SUB-REGIONAL CLINIC, TOKSOOK BAY, AK 99637
(907) 543-6300
Mailing address
PO BOX 37028, TOKSOOK BAY, AK 99637
(907) 427-3500
(907) 427-3526
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
629
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MDA0196
—
AK
Enumeration date
05/01/2007
Last updated
09/07/2010
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