=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013724293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AUTONOMOLOGY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2024
-----------------------------------------------------
Last Update Date | 08/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2925 DEBARR RD STE 240
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99508-2959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-339-4657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 AIRPORT HEIGHTS DR STE 280
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99508-2971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-523-5372
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LUKE LIU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-523-5372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------