Individual
PENNY K PUHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ETC
Contact information
Practice address
104 CENTER AVE STE 100, KODIAK, AK 99615-6393
(907) 486-4183
(907) 486-4233
Mailing address
104 CENTER AVE STE 100, KODIAK, AK 99615-6393
(907) 486-4183
(907) 486-4233
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1842
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0124
—
AK
05
—
MD1532
—
AK
Enumeration date
01/30/2007
Last updated
07/27/2007
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