Healthcare Provider Details

I. General information

NPI: 1003459298
Provider Name (Legal Business Name): ALASKA BLEEDING DISORDER CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE OTIS PKWY STE 312
ANCHORAGE AK
99508-5231
US

IV. Provider business mailing address

PO BOX 241769
ANCHORAGE AK
99524-1769
US

V. Phone/Fax

Practice location:
  • Phone: 907-917-9235
  • Fax:
Mailing address:
  • Phone: 907-770-2380
  • Fax: 907-770-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA L SCHULZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 907-917-9235