Healthcare Provider Details

I. General information

NPI: 1134190440
Provider Name (Legal Business Name): GERALD EDWARD YORK II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 PIPER STREET SUITE A
ANCHORAGE AK
99508
US

IV. Provider business mailing address

3650 PIPER STREET SUITE A
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-4624
  • Fax: 907-222-4651
Mailing address:
  • Phone: 907-222-4624
  • Fax: 907-222-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberM5597
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM5597
License Number StateTX

VII. Legacy identifiers

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

# 1
Identifier7617025
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer
# 2
Identifier808256800
Identifier TypeMEDICAID
Identifier StateID
Identifier Issuer
# 3
Identifier8VGJWWO5A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer
# 4
Identifier200105670 B
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer
# 5
Identifier1939340 03
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer
# 6
Identifier226608300
Identifier TypeMEDICAID
Identifier StateMD
Identifier Issuer
# 7
Identifier2902121
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: