Healthcare Provider Details

I. General information

NPI: 1972570604
Provider Name (Legal Business Name): JEAN TSIGONIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NOBLE ST
FAIRBANKS AK
99701-4922
US

IV. Provider business mailing address

1001 NOBLE ST
FAIRBANKS AK
99701-4922
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3511
  • Fax: 907-459-3588
Mailing address:
  • Phone: 907-459-3500
  • Fax: 907-459-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1833
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number1833
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: