Healthcare Provider Details

I. General information

NPI: 1063405967
Provider Name (Legal Business Name): JAMES M WOJCIEHOWSKI PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 INDEPENDENCE DR SUITE 900
ANCHORAGE AK
99507-4615
US

IV. Provider business mailing address

9500 INDEPENDENCE DR SUITE 900
ANCHORAGE AK
99507-4615
US

V. Phone/Fax

Practice location:
  • Phone: 907-522-1341
  • Fax: 907-522-1343
Mailing address:
  • Phone: 907-522-1341
  • Fax: 907-522-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number379
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: