Organization
CAMELOT FAMILY HEALTH LLC
Active
Other names
Dr David Chisholm
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID R CHISHOLM M.D. (OWNER)
(907) 357-6180
Entity
Organization
Contact information
Practice address
500 E SWANSON AVE, STE 3, WASILLA, AK 99654-7197
(907) 357-6180
(907) 357-6184
Mailing address
500 E SWANSON AVE, STE 3, WASILLA, AK 99654-7197
(907) 357-6180
(907) 357-6184
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009915
—
AK
Enumeration date
01/06/2017
Last updated
01/06/2017
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