Healthcare Provider Details

I. General information

NPI: 1972552891
Provider Name (Legal Business Name): EAR, NOSE AND THROAT SPECIALISTS ALASKA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 PIPER STREET SUITE#S433
ANCHORAGE AK
99508
US

IV. Provider business mailing address

3831 PIPER STREET SUITE#S433
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-563-3515
  • Fax: 907-563-3541
Mailing address:
  • Phone: 907-563-3515
  • Fax: 907-563-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD PARRISH
Title or Position: SECRETARY / TREASURER
Credential: MD
Phone: 907-563-3515