Healthcare Provider Details

I. General information

NPI: 1639267768
Provider Name (Legal Business Name): RONALD ROBERT HAGGETT A.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 DEBARR RD. SUITE 300
ANCHORAGE AK
99508
US

IV. Provider business mailing address

2925 DEBARR RD. SUITE # 300
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-279-3155
  • Fax:
Mailing address:
  • Phone: 501-686-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA02948
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1372
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: