Healthcare Provider Details

I. General information

NPI: 1306018106
Provider Name (Legal Business Name): LAURIE J. BLEICHER, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 PIPER ST SUITE U-422
ANCHORAGE AK
99508-6904
US

IV. Provider business mailing address

3851 PIPER ST SUITE U-422
ANCHORAGE AK
99508-6904
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-2533
  • Fax:
Mailing address:
  • Phone: 907-561-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2038
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number2038
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2038
License Number StateAK

VIII. Authorized Official

Name: DR. LAURIE J. BLEICHER
Title or Position: SOLE MEMBER
Credential: M.D.
Phone: 907-561-2533