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General NPI Number Information
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NPI Number | 1346496866
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Entity Type | Individual
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Provider Name | KENNETH G WAUGH PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/15/2008
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 131 LINBLAD AVE.
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City | GIRDWOOD
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State | AK
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Zip | 99587
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Country | US
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Telephone | 907-783-2311
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 651
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City | GIRDWOOD
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State | AK
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Zip | 99587-0651
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Country | US
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Telephone | 907-783-2311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 507
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License Number State | AK
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