Organization
MAT-SU EAR, NOSE, THROAT & FACIAL PLASTICS, INC.
Active
Other names
Facial Plastic ENT & Associates, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW RICHARD PULLIAM MD (PRESIDENT)
(907) 745-9200
Entity
Organization
Contact information
Practice address
2490 SOUTH WOODWORTH LOOP, 201, PALMER, AK 99645
(907) 745-9200
(907) 745-9201
Mailing address
2490 SOUTH WOODWORTH LOOP, 201, PALMER, AK 99645
(907) 745-9200
(907) 745-9201
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4516
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020801
—
AK
05
—
MD3510
—
AK
Enumeration date
08/16/2006
Last updated
12/27/2017
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