Healthcare Provider Details

I. General information

NPI: 1205330784
Provider Name (Legal Business Name): JULIA D SHATTEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

542 W 2ND AVE
ANCHORAGE AK
99501-2208
US

IV. Provider business mailing address

542 W 2ND AVE
ANCHORAGE AK
99501-2208
US

V. Phone/Fax

Practice location:
  • Phone: 907-276-1617
  • Fax:
Mailing address:
  • Phone: 907-276-1617
  • Fax: 907-264-2665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number80123
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number206935
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: