Healthcare Provider Details

I. General information

NPI: 1770302374
Provider Name (Legal Business Name): AFT MEDICAL AK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4739 EGRET ROCK CIR
ANCHORAGE AK
99507-4390
US

IV. Provider business mailing address

4739 EGRET ROCK CIR
ANCHORAGE AK
99507-4390
US

V. Phone/Fax

Practice location:
  • Phone: 559-284-4135
  • Fax:
Mailing address:
  • Phone: 559-284-4135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN T MOORE
Title or Position: CEO / MEDICAL DIRECTOR
Credential: MD
Phone: 831-917-8761