Organization
THE DERMATOLOGY AND SKIN CANCER CLINIC OF ALASKA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATHEW M CANNAVA M.D. (PRESIDENT)
(907) 262-7546
Entity
Organization
Contact information
Practice address
180 E BELUGA AVE, SOLDOTNA, AK 99669-8002
(907) 262-7546
(907) 262-7599
Mailing address
PO BOX 780, SOLDOTNA, AK 99669-0780
(907) 262-7546
(907) 262-7599
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207N00000X
Dermatology Physician
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
207ND0900X
Dermatopathology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD16711
—
AK
Enumeration date
02/28/2007
Last updated
12/06/2017
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