MEDICARE: DR. LETHA C ARCHER M.D

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	208000000X	Pediatrics Physician	7546	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	:	1699774299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LETHA C ARCHER M.D

Provider Business Mailing Address
First Line	:	1875 UNIVERSITY AVE S UNIT 1
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-4906
Country	:	US
Telephone Number	:	907-328-0875
Fax Number	:	907-328-0865

Provider Business Practice Location Address
First Line	:	1875 UNIVERSITY AVE S UNIT 1
Second Line	:
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-4906
Country	:	US
Telephone Number	:	907-328-0875
Fax Number	:	907-328-0865

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	01/05/2021

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Directions to “ DR. LETHA C ARCHER M.D” Practice Location

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