Healthcare Provider Details

I. General information

NPI: 1053931717
Provider Name (Legal Business Name): DR. EDUARDO CADORE GUZZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date: 01/10/2022
Reactivation Date: 02/21/2022

III. Provider practice location address

4015 LAKE OTIS PKWY STE 201
ANCHORAGE AK
99508-5235
US

IV. Provider business mailing address

4015 LAKE OTIS PKWY STE 201
ANCHORAGE AK
99508-5235
US

V. Phone/Fax

Practice location:
  • Phone: 907-375-5200
  • Fax: 907-375-5203
Mailing address:
  • Phone: 907-375-5200
  • Fax: 907-375-5203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number242945
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number242945
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: