Healthcare Provider Details

I. General information

NPI: 1730175662
Provider Name (Legal Business Name): RANDALL CURTIS ZERNZACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4441 DIPLOMACY DR FL 5
ANCHORAGE AK
99508-5910
US

IV. Provider business mailing address

4441 DIPLOMACY DR FL 5
ANCHORAGE AK
99508-5910
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-4205
  • Fax: 907-729-8718
Mailing address:
  • Phone: 907-729-4205
  • Fax: 907-729-8718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number125677
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: