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NPI Code Detail

MEDICARE: DR. SCOTT C DEBERARD DO

MEDICARE: DR. SCOTT C DEBERARD DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianAK 4406AK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AK4406OTHERAKLICENSE

General Provider Information

NPI Number : 1194729731
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT C DEBERARD DO
Provider Business Mailing Address
First Line : 9220 LAKE OTIS PKWY
Second Line : STE 9
City : ANCHORAGE
State : AK
Zip : 99507-4249
Country : US
Telephone Number : 907-344-0200
Fax Number : 907-344-0214
Provider Business Practice Location Address
First Line : 9220 LAKE OTIS PKWY
Second Line : STE 9
City : ANCHORAGE
State : AK
Zip : 99507-4249
Country : US
Telephone Number : 907-344-0200
Fax Number : 907-344-0214
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 07/08/2007

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Directions to “ DR. SCOTT C DEBERARD DO” Practice Location

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