Healthcare Provider Details

I. General information

NPI: 1467432278
Provider Name (Legal Business Name): MONICA CLAUDIA GAUPP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16958 N EAGLE RIVER LOOP RD
EAGLE RIVER AK
99577
US

IV. Provider business mailing address

PO BOX 771455
EAGLE RIVER AK
99577-1455
US

V. Phone/Fax

Practice location:
  • Phone: 907-622-9900
  • Fax: 907-622-4038
Mailing address:
  • Phone: 907-622-9900
  • Fax: 907-622-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAK4872
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: