Organization
FAIRWEATHER DEADHORSE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY R BOLAM (GROUP PRACTICE MANAGER)
(907) 248-8008
Entity
Organization
Contact information
Practice address
500 1ST STREET, DEADHORSE, AK 99734-0000
(907) 685-1800
(907) 685-1803
Mailing address
PO BOX 200134, ANCHORAGE, AK 99520-0134
(907) 248-8008
(907) 248-8208
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
940479
AK
Other
Enumeration date
07/11/2012
Last updated
08/09/2013
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