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General NPI Number Information
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NPI Number | 1841469996
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Entity Type | Organization
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Legal Business Name | PENINSULA EAR, NOSE & THROAT CLINIC, INC.
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 220 SPUR VIEW DR
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City | KENAI
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State | AK
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Zip | 99611-6880
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Country | US
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Telephone | 907-283-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 220 SPUR VIEW DR
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City | KENAI
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State | AK
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Zip | 99611-6880
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Country | US
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Telephone | 907-283-5400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES VICTOR ZIRUL
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Credential | D.O.
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Telephone | 907-283-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 911644
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License Number State | AK
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