Healthcare Provider Details

I. General information

NPI: 1639645021
Provider Name (Legal Business Name): ALASKA MEDICAL SPECIALTY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE OTIS PKWY STE 218
ANCHORAGE AK
99508-5230
US

IV. Provider business mailing address

16340 GOLDEN VIEW DR
ANCHORAGE AK
99516-4952
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-5007
  • Fax:
Mailing address:
  • Phone: 907-830-4643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALFRED LONSER
Title or Position: OWNER
Credential: MD
Phone: 907-561-5007