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General NPI Number Information
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NPI Number | 1912133588
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Entity Type | Individual
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Provider Name | KRISTOFOR A SARGENT
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Gender | Male
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Dates
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Enumeration Date | 06/09/2009
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 1201 E 36TH AVE
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City | ANCHORAGE
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State | AK
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Zip | 99508-4372
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Country | US
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Telephone | 907-562-9229
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 196276
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City | ANCHORAGE
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State | AK
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Zip | 99519-6276
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Country | US
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Telephone | 907-212-6522
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Fax | 907-212-6593
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 5181
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MEDS7393
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License Number State | AK
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