Healthcare Provider Details

I. General information

NPI: 1487713848
Provider Name (Legal Business Name): ALASKA ONCOLOGY AND HEMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 DEBARR ROAD SUITE 300
ANCHORAGE AK
99508
US

IV. Provider business mailing address

PO BOX 196618
ANCHORAGE AK
99519-6618
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 Number282420
License Number StateAK

VIII. Authorized Official

Name: WENDY A JOHNSON
Title or Position: REIMBURSEMENT MANAGER
Credential:
Phone: 907-257-9804