Healthcare Provider Details

I. General information

NPI: 1649362948
Provider Name (Legal Business Name): JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3268 HOSPITAL DR STE B
JUNEAU AK
99801-7800
US

IV. Provider business mailing address

3268 HOSPITAL DR STE B
JUNEAU AK
99801-7800
US

V. Phone/Fax

Practice location:
  • Phone: 907-586-1717
  • Fax: 907-586-2677
Mailing address:
  • Phone: 907-586-1717
  • Fax: 907-586-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2531
License Number StateAK

VIII. Authorized Official

Name: DR. NICHOLAS D NEWBURY
Title or Position: OWNER
Credential: D.O.
Phone: 907-586-1717