Organization
ADL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE D CLARK (AUTHORIZED OFFICIAL)
(907) 261-5806
Entity
Organization
Contact information
Practice address
3200 PROVIDENCE DR, ANCHORAGE, AK 99508
(907) 565-2211
(907) 565-8066
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(419) 866-1804
(418) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MDG616
—
AK
Enumeration date
10/25/2005
Last updated
05/22/2018
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