Individual
PAUL FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
34300 TALKEETNA S SPUR RD, TALKEETNA, AK 99676
(907) 733-2273
(907) 733-1735
Mailing address
950 E BOGARD RD STE 233, WASILLA, AK 99654-7185
(907) 376-2273
(907) 733-1735
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3728
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD44651
—
AK
01
—
P00115873
RAILROAD MEDICARE PIN#
AK
Enumeration date
08/15/2006
Last updated
07/12/2021
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