Healthcare Provider Details

I. General information

NPI: 1083322762
Provider Name (Legal Business Name): ERIC JOSEPH PAVIL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SAN JERONIMO DR STE 210
ANCHORAGE AK
99508-2870
US

IV. Provider business mailing address

3600 SAN JERONIMO DR STE 210
ANCHORAGE AK
99508-2870
US

V. Phone/Fax

Practice location:
  • Phone: 907-793-3600
  • Fax: 907-793-3250
Mailing address:
  • Phone: 907-793-3600
  • Fax: 907-793-3250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: