Healthcare Provider Details

I. General information

NPI: 1194882282
Provider Name (Legal Business Name): GREGORY JOHN SEMANCIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4120 LAUREL ST SUITE 201
ANCHORAGE AK
99508-5392
US

IV. Provider business mailing address

4120 LAUREL ST SUITE 201
ANCHORAGE AK
99508-5392
US

V. Phone/Fax

Practice location:
  • Phone: 907-743-6944
  • Fax: 907-743-0694
Mailing address:
  • Phone: 907-743-6944
  • Fax: 907-743-0694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number7076
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: