Organization
SAMUEL A MCCONKEY III MD PC
Active
Organization
SAMUEL A MCCONKEY III MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL A MCCONKEY MD (OWNER)
(907) 456-7767
Entity
Organization
Contact information
Practice address
1521 STACIA ST, FAIRBANKS, AK 99701-6135
(907) 456-4822
Mailing address
315 ILLINOIS ST, FAIRBANKS, AK 99701-2910
(907) 456-7767
(907) 456-8050
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
849
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD0849
—
AK
Enumeration date
02/02/2007
Last updated
12/09/2010
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