Healthcare Provider Details

I. General information

NPI: 1114340262
Provider Name (Legal Business Name): JOHN REXROTH JR. MPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 LAKE OTIS PKWY STE 300
ANCHORAGE AK
99508-5234
US

IV. Provider business mailing address

3801 LAKE OTIS PKWY STE 300
ANCHORAGE AK
99508-5234
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-2277
  • Fax: 907-563-3460
Mailing address:
  • Phone: 907-562-2277
  • Fax: 907-563-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number153530
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number135364
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: