Individual
DICK BAKER KUGZRUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CHA III
Contact information
Practice address
85058 WEST CLARENCE ROAD, BREVIG, AK 99785
(907) 642-4311
(907) 642-2216
Mailing address
85058 WEST CLARENCE ROAD, BREVIG, AK 99785
(907) 642-4311
(907) 642-2216
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
12-1178-III
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12-1178-III
CHA III
AK
Enumeration date
06/12/2012
Last updated
06/12/2012
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