Individual
TAE DUK OK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
800 CORDOVA ST, ANCHORAGE, AK 99501-3717
(907) 222-7612
Mailing address
PO BOX 283, SAINT PAUL ISLAND, AK 99660-0283
(907) 546-8300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
541
AK
Other
Enumeration date
06/03/2007
Last updated
07/08/2007
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