Healthcare Provider Details

I. General information

NPI: 1689667586
Provider Name (Legal Business Name): ROY E HOWARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 E 82ND AVE STE 204
ANCHORAGE AK
99518-3159
US

IV. Provider business mailing address

615 E 82ND AVE STE 204
ANCHORAGE AK
99518-3159
US

V. Phone/Fax

Practice location:
  • Phone: 907-865-8455
  • Fax: 913-246-4901
Mailing address:
  • Phone: 907-865-8455
  • Fax: 913-246-4901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1495
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: