Healthcare Provider Details

I. General information

NPI: 1407971369
Provider Name (Legal Business Name): JOHN P. MUFFOLETTO MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 DEBARR RD SUITE 290
ANCHORAGE AK
99508-2953
US

IV. Provider business mailing address

2751 DEBARR RD SUITE 290
ANCHORAGE AK
99508-2953
US

V. Phone/Fax

Practice location:
  • Phone: 907-276-1046
  • Fax: 907-222-6898
Mailing address:
  • Phone: 907-276-1046
  • Fax: 907-222-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3873
License Number StateAK

VIII. Authorized Official

Name: DR. JOHN P. MUFFOLETTO
Title or Position: PRESIDENT
Credential: MD
Phone: 907-276-1046