Healthcare Provider Details

I. General information

NPI: 1356437792
Provider Name (Legal Business Name): FAIRBANKS RADIATION ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COWLES STREET
FAIRBANKS AK
99701
US

IV. Provider business mailing address

PO BOX 232069
ANCHORAGE AK
99523-2069
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-5380
  • Fax: 907-743-2640
Mailing address:
  • Phone: 907-458-5380
  • Fax: 907-743-2641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: L RODNEY COOK
Title or Position: GENERAL PARTNER
Credential: MD
Phone: 907-261-3186