Healthcare Provider Details

I. General information

NPI: 1649431354
Provider Name (Legal Business Name): AMY BUKAC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY COOKRO

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 FIRST AVENUE
SEWARD AK
99664
US

IV. Provider business mailing address

3760 PIPER ST SUITE 1060
ANCHORAGE AK
99508-4665
US

V. Phone/Fax

Practice location:
  • Phone: 907-224-5205
  • Fax:
Mailing address:
  • Phone: 907-212-6522
  • Fax: 907-212-6593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTRN12295
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6046
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: