Healthcare Provider Details

I. General information

NPI: 1366640070
Provider Name (Legal Business Name): RAYMOND E. ANDREASSEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 SERVICE STREET
DELTA JUNCTION AK
99737-9440
US

IV. Provider business mailing address

HC 60 BOX 4860
DELTA JUNCTION AK
99737-9440
US

V. Phone/Fax

Practice location:
  • Phone: 907-895-5100
  • Fax: 907-895-5133
Mailing address:
  • Phone: 907-895-5100
  • Fax: 907-895-5133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAA 2011
License Number StateAK

VIII. Authorized Official

Name: MR. DAVID F. CRAWFORD
Title or Position: ADMINISTRATOR
Credential: M.B.A.
Phone: 907-895-5100