Organization
ALYESKA FAMILY MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIO A LANZA MD (PRESIDENT)
(907) 258-1258
Entity
Organization
Contact information
Practice address
3841 PIPER STREET, SUITE T3162, ANCHORAGE, AK 99508
(907) 258-1258
(907) 258-1257
Mailing address
3841 PIPER STREET, SUITE T3162, ANCHORAGE, AK 99508
(907) 258-1258
(907) 258-1257
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
3753
AK
208D00000X
General Practice Physician
3905
AK
208D00000X
General Practice Physician
4503
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
161169
PTAN
AK
01
—
161406
MEDICARE PTAN
AK
05
—
MD3385
—
AK
05
—
MD37532
—
AK
Enumeration date
05/31/2007
Last updated
02/26/2008
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