Healthcare Provider Details

I. General information

NPI: 1932271152
Provider Name (Legal Business Name): TIMOTHY COALWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 E NORTHERN LIGHTS BLVD
ANCHORAGE AK
99508-4103
US

IV. Provider business mailing address

3801 UNIVERSITY LAKE DR STE 301
ANCHORAGE AK
99508-4658
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-8486
  • Fax:
Mailing address:
  • Phone: 907-777-1850
  • Fax: 907-561-8891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3354
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: