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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: