Healthcare Provider Details

I. General information

NPI: 1336443969
Provider Name (Legal Business Name): MARK E RICHEY MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 12/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AIRPORT HEIGHTS DR STE 205
ANCHORAGE AK
99508-2965
US

IV. Provider business mailing address

1200 AIRPORT HEIGHTS DR STE 205
ANCHORAGE AK
99508-2965
US

V. Phone/Fax

Practice location:
  • Phone: 907-272-4443
  • Fax: 907-272-2262
Mailing address:
  • Phone: 907-272-4443
  • Fax: 907-272-2262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number3291
License Number StateAK

VIII. Authorized Official

Name: DR. MARK E RICHEY
Title or Position: PRESIDENT
Credential: MD
Phone: 907-272-4443