Healthcare Provider Details

I. General information

NPI: 1588602577
Provider Name (Legal Business Name): ROMAN L KUPCZYNSKI CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 DIPLOMACY DR ATTN: SHERRY REEDY
ANCHORAGE AK
99508-5926
US

IV. Provider business mailing address

4315 DIPLOMACY DR ATTN: SHERRY REEDY
ANCHORAGE AK
99508-5926
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-3971
  • Fax: 907-729-1542
Mailing address:
  • Phone: 907-729-3971
  • Fax: 907-729-1542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number7953
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number106
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: