Healthcare Provider Details

I. General information

NPI: 1114936499
Provider Name (Legal Business Name): GENEVA WOODS EAR, NOSE AND THROAT ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 RHONE CIR SUITE 203
ANCHORAGE AK
99508-5051
US

IV. Provider business mailing address

3730 RHONE CIR SUITE 203
ANCHORAGE AK
99508-5051
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-3515
  • Fax:
Mailing address:
  • Phone: 907-563-3515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENDA R BOGOWITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-563-3515