Individual
DR. BRIAN DOMENIC VACCA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10928 EAGLE RIVER RD, SUITE 104, EAGLE RIVER, AK 99577-8078
(907) 622-1300
Mailing address
10928 EAGLE RIVER RD, SUITE 104, EAGLE RIVER, AK 99577-8078
(907) 622-1300
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
103783
AK
208100000X
Physical Medicine & Rehabilitation Physician
51455
MN
Other
Enumeration date
10/03/2006
Last updated
06/07/2016
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