Healthcare Provider Details

I. General information

NPI: 1801086731
Provider Name (Legal Business Name): JERRY M. ORREN MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 DEBARR RD SUITE 360
ANCHORAGE AK
99508-2953
US

IV. Provider business mailing address

1120 HUFFMAN RD PMB 205, SUITE 23
ANCHORAGE AK
99515-3516
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-3601
  • Fax: 907-563-7601
Mailing address:
  • Phone: 907-563-3601
  • Fax: 907-563-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number1290
License Number StateAK

VIII. Authorized Official

Name: DR. JERRY M. ORREN
Title or Position: PRESIDENT
Credential: M. D,
Phone: 907-563-3601