Healthcare Provider Details

I. General information

NPI: 1144292533
Provider Name (Legal Business Name): ROYAL PEARSON KIEHL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W BENSON BLVD SUITE 315
ANCHORAGE AK
99503-3679
US

IV. Provider business mailing address

PO BOX 111810
ANCHORAGE AK
99511-1810
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-4009
  • Fax: 907-929-4902
Mailing address:
  • Phone: 907-929-4009
  • Fax: 907-929-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1204
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: