Organization
SOUTHEAST RADIOLOGY CONSULTANTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA J SHANLEY M.D. (MANAGING MEMBER)
(907) 321-1953
Entity
Organization
Contact information
Practice address
3260 HOSPITAL DR, JUNEAU, AK 99801-7808
(907) 796-8631
Mailing address
3260 HOSPITAL DR, JUNEAU, AK 99801-7808
(907) 796-8631
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5533
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1014647
—
AK
Enumeration date
06/05/2015
Last updated
06/05/2015
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