Healthcare Provider Details

I. General information

NPI: 1881084101
Provider Name (Legal Business Name): DOUGLAS KATEIN-TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 06/27/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6973 ZUCKERT AVE
JBER AK
99506
US

IV. Provider business mailing address

6973 ZUCKERT AVE
ANCHORAGE AK
99506
US

V. Phone/Fax

Practice location:
  • Phone: 907-551-7662
  • Fax: 907-377-2763
Mailing address:
  • Phone: 907-377-6526
  • Fax: 907-377-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101260418
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101260418
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: