MEDICARE: JOSE PRIMO N ANZILOTTI MD

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
1	208D00000X	General Practice Physician	4141	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619955606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE PRIMO N ANZILOTTI MD

Provider Business Mailing Address
First Line	:	PO BOX 241769
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99524-1769
Country	:	US
Telephone Number	:	907-770-2380
Fax Number	:	907-770-2390

Provider Business Practice Location Address
First Line	:	PARKS HIGHWAY MILE 69.1
Second Line	:
City	:	WILLOW
State	:	AK
Zip	:	99688
Country	:	US
Telephone Number	:	907-495-4362
Fax Number	:	907-495-4363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/08/2007

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