Healthcare Provider Details

I. General information

NPI: 1871143834
Provider Name (Legal Business Name): JASON KOPSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 LAKE OTIS PKWY STE 322
ANCHORAGE AK
99508-5231
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 907-562-1234
  • Fax: 907-673-8319
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 Number252036
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: