Healthcare Provider Details

I. General information

NPI: 1336348937
Provider Name (Legal Business Name): AURORA DIAGNOSTIC IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3419 AIRPORT WAY STE D
FAIRBANKS AK
99709-4761
US

IV. Provider business mailing address

PO BOX 751
GIRDWOOD AK
99587-0751
US

V. Phone/Fax

Practice location:
  • Phone: 907-474-2002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4098
License Number StateAK

VIII. Authorized Official

Name: DR. ROBERT L BRIDGES
Title or Position: OWNER
Credential:
Phone: 907-352-9233