Healthcare Provider Details

I. General information

NPI: 1497744965
Provider Name (Legal Business Name): JAMES CONRAD SPILS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 02/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 LAUREL ST
ANCHORAGE AK
99508-5300
US

IV. Provider business mailing address

P.O. BOX 241689
ANCHORAGE AK
99524-1889
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-1800
  • Fax: 907-563-1802
Mailing address:
  • Phone: 907-563-1777
  • Fax: 907-561-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number3440
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: