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General NPI Number Information
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NPI Number | 1629240874
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Entity Type | Organization
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Legal Business Name | ORTHOPAEDIC TRIAGE OF FAIRBANKS, INC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 07/24/2013
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Provider Practice Location Address
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Address Line | 1919 LATHROP, SUITE 209
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City | FAIRBANKS
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State | AK
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Zip | 99701
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Country | US
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Telephone | 907-452-4469
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Fax | 907-451-9480
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Provider Business Mailing Address
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Address Line | 1919 LATHROP, SUITE 209
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City | FAIRBANKS
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State | AK
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Zip | 99701
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Country | US
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Telephone | 907-452-4469
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Fax | 907-451-9480
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL T WEBER
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Credential | PA-C
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Telephone | 907-452-4446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 171
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License Number State | AK
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