Healthcare Provider Details

I. General information

NPI: 1376075697
Provider Name (Legal Business Name): SEVEN PRINCIPLES THERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W NORTHERN LIGHTS BVLD
ANCHORAGE AK
99503
US

IV. Provider business mailing address

2901 ILLIAMNA AVE
ANCHORAGE AK
99517-1219
US

V. Phone/Fax

Practice location:
  • Phone: 907-302-8205
  • Fax:
Mailing address:
  • Phone: 907-342-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMEDS 7369
License Number StateAK

VIII. Authorized Official

Name: DR. DAVID ROLAND MACK
Title or Position: PSYCHIATRIST OWNER
Credential: M.D.
Phone: 907-342-9500