Healthcare Provider Details

I. General information

NPI: 1417512005
Provider Name (Legal Business Name): GREGORY A AIRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 BARTLETT ST
HOMER AK
99603-7000
US

IV. Provider business mailing address

4300 BARTLETT ST
HOMER AK
99603-7000
US

V. Phone/Fax

Practice location:
  • Phone: 907-435-3090
  • Fax: 888-375-6254
Mailing address:
  • Phone: 907-435-3090
  • Fax: 888-375-6254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPG193629
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number202069
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number67694
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: