Healthcare Provider Details

I. General information

NPI: 1487310769
Provider Name (Legal Business Name): SEAN EDWARD ALLWORTH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E DIMOND BLVD STE 103
ANCHORAGE AK
99515-2001
US

IV. Provider business mailing address

1100 E DIMOND BLVD STE 103
ANCHORAGE AK
99515-2001
US

V. Phone/Fax

Practice location:
  • Phone: 907-267-5890
  • Fax: 844-670-3889
Mailing address:
  • Phone: 907-267-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number233572
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: