Healthcare Provider Details

I. General information

NPI: 1710069380
Provider Name (Legal Business Name): BRUCE CHANDLER MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 C ST STE 540
ANCHORAGE AK
99503
US

IV. Provider business mailing address

3600 C ST STE 540
ANCHORAGE AK
99503
US

V. Phone/Fax

Practice location:
  • Phone: 907-269-8000
  • Fax:
Mailing address:
  • Phone: 907-269-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2307
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2307
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: