Healthcare Provider Details

I. General information

NPI: 1063441178
Provider Name (Legal Business Name): DENNIS PATRICK SERIE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 02/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22742 OBERG RD
CHUGIAK AK
99567-5495
US

IV. Provider business mailing address

PO BOX 671764
CHUGIAK AK
99567-1764
US

V. Phone/Fax

Practice location:
  • Phone: 907-854-8452
  • Fax: 907-222-4641
Mailing address:
  • Phone: 907-854-8452
  • Fax: 907-222-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number633
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: