Organization
PACIFIC NORTHWEST RADIOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BURT LOESSBERG (ADMINISTRATOR)
(541) 687-7134
Entity
Organization
Contact information
Practice address
12175 GLACIER HWY, UNIT E 203, JUNEAU, AK 99801-8630
(907) 228-8300
Mailing address
PO BOX 26570, FRESNO, CA 93729-6570
(541) 687-7134
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
314344
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MDG34OR
—
OR
Enumeration date
04/18/2007
Last updated
01/15/2008
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