Healthcare Provider Details

I. General information

NPI: 1427099043
Provider Name (Legal Business Name): RONALD NORBERT TALAGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KANAKANAK RD. MEDICAL STAFF DEPARTMENT
DILLINGHAM AK
99576-0130
US

IV. Provider business mailing address

6000 KANAKANAK RD MEDICAL STAFF DEPARTMENT
DILLINGHAM AK
99576-0130
US

V. Phone/Fax

Practice location:
  • Phone: 907-842-5201
  • Fax: 907-842-9250
Mailing address:
  • Phone: 907-842-5201
  • Fax: 907-842-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number149253-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD026395E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6145
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: