Healthcare Provider Details

I. General information

NPI: 1588915755
Provider Name (Legal Business Name): ALASKA PEDIATRICS ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 E DUNBAR DR SUITE F
WASILLA AK
99654-7758
US

IV. Provider business mailing address

5050 E DUNBAR DR SUITE F
WASILLA AK
99654-7758
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-5437
  • Fax: 907-357-1854
Mailing address:
  • Phone: 907-357-5437
  • Fax: 907-357-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5749
License Number StateAK

VII. Legacy identifiers

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

# 1
IdentifierMD5506
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: DR. CECILIA HOWELL-CANADA
Title or Position: OWNER
Credential: MD
Phone: 907-357-5437