=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679642714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE R VRABLIK MD APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 LATHROP ST STE 108
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-452-5771
-----------------------------------------------------
Fax | 907-452-5544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1919 LATHROP ST STE 108
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-452-5771
-----------------------------------------------------
Fax | 907-452-5544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | DR. GEORGE R VRABLIK
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 907-452-5771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 1663
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------