Organization
MEADOW CREEK HEALTHCARE LLC
Active
Other names
Meadow Creek Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS A FENGER PH.D, P.A. (OWNER)
(907) 694-3303
Entity
Organization
Contact information
Practice address
16839 PARK PLACE ST, SAME, EAGLE RIVER, AK 99577-7819
(907) 694-3303
(907) 694-4773
Mailing address
16839 PARK PLACE ST, SAME, EAGLE RIVER, AK 99577-7819
(907) 694-3303
(907) 694-4773
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
423
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MPG0123
—
AK
Enumeration date
05/09/2011
Last updated
05/09/2011
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