Individual
MR. MARK PATRICK MOUTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
751 OLD RICHARDSON HWY, STE # 200, FAIRBANKS, AK 99701-7813
(907) 451-6561
(907) 451-4847
Mailing address
751 OLD RICHARDSON HWY, STE # 200, FAIRBANKS, AK 99701-7813
(907) 451-6561
(907) 451-4847
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
696
AK
363AM0700X
Medical Physician Assistant
696
AK
363AS0400X
Surgical Physician Assistant
Primary
696
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
696
STATE MEDICAL LICENSE
AK
Enumeration date
07/07/2006
Last updated
09/11/2025
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