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General NPI Number Information
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NPI Number | 1366640070
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Entity Type | Organization
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Legal Business Name | RAYMOND E. ANDREASSEN
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 10/07/2010
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Provider Practice Location Address
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Address Line | 2360 SERVICE STREET
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City | DELTA JUNCTION
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State | AK
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Zip | 99737-9440
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Country | US
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Telephone | 907-895-5100
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Fax | 907-895-5133
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Provider Business Mailing Address
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Address Line | HC 60 BOX 4860
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City | DELTA JUNCTION
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State | AK
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Zip | 99737-9440
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Country | US
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Telephone | 907-895-5100
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Fax | 907-895-5133
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. DAVID F. CRAWFORD
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Credential | M.B.A.
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Telephone | 907-895-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | AA 2011
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License Number State | AK
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