Healthcare Provider Details

I. General information

NPI: 1689312886
Provider Name (Legal Business Name): REBECCA PHILPOTT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-4000
  • Fax:
Mailing address:
  • Phone: 907-361-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number255486
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberE17501
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: