Healthcare Provider Details

I. General information

NPI: 1376038075
Provider Name (Legal Business Name): IVAN MAURICIO GUILLERMO COLUMBUS MORALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 DEBARR RD, ALASKA REGIONAL HOSPITAL
ANCHORAGE AK
99508
US

IV. Provider business mailing address

7020 NORTHWOOD ST UNIT 209
ANCHORAGE AK
99502
US

V. Phone/Fax

Practice location:
  • Phone: 907-276-1131
  • Fax:
Mailing address:
  • Phone: 313-699-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number176796
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: