Healthcare Provider Details

I. General information

NPI: 1063914257
Provider Name (Legal Business Name): JONATHON ROSTAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 DEBARR RD STE 300
ANCHORAGE AK
99508-2974
US

IV. Provider business mailing address

2925 DEBARR RD STE 300
ANCHORAGE AK
99508-2974
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-3155
  • Fax: 907-279-3154
Mailing address:
  • Phone: 907-279-3155
  • Fax: 907-279-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number245853
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: