Individual
EARL POLK III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5016 NOEL POLTY BLVD, BETHEL, AK 99559-1029
(907) 543-6800
Mailing address
PO BOX 1029, ATTN: BH MCCANN TREATMENT CENTER, BETHEL, AK 99559-1029
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006017
—
AK
05
—
1020986
—
AK
05
—
1584987
—
AK
Enumeration date
03/03/2015
Last updated
03/03/2015
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