Individual
BEN PROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8505 OLD DAIRY RD, JUNEAU, AK 99801-6921
(907) 790-4111
Mailing address
8505 OLD DAIRY RD, JUNEAU, AK 99801-6921
(907) 790-4111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
11/05/2021
Last updated
11/05/2021
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