Individual
DR. TY R VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 BOGARD RD STE 100, BUILDING A, WASILLA, AK 99654-6563
(907) 352-6200
(907) 373-0725
Mailing address
1700 BOGARD RD STE 100, BUILDING A, WASILLA, AK 99654-6563
(907) 352-6200
(907) 373-0725
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5545
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD61582
—
AK
Enumeration date
07/30/2006
Last updated
07/08/2007
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