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General NPI Number Information
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NPI Number | 1053619098
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Entity Type | Organization
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Legal Business Name | ALPINE DERMATOLOGY, LLC
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 3268 HOSPITAL DR STE A
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City | JUNEAU
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State | AK
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Zip | 99801-7800
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Country | US
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Telephone | 907-523-5411
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Fax | 907-523-9884
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Provider Business Mailing Address
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Address Line | 3225 HOSPITAL DR UNIT 101A
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City | JUNEAU
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State | AK
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Zip | 99801-7863
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Country | US
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Telephone | 907-523-5411
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Fax | 907-523-9884
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT CERTIFIED
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Name | KRIS J MILLER
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Credential | PAC
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Telephone | 907-523-5411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 944
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License Number State | AK
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