MEDICARE: DOUG A VERMILLION MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MEDS5698	AK

General Provider Information

NPI Number	:	1336114388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUG A VERMILLION MD

Provider Business Mailing Address
First Line	:	4100 LAKE OTIS PKWY STE 220
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5230
Country	:	US
Telephone Number	:	907-563-3145
Fax Number	:	833-464-5196

Provider Business Practice Location Address
First Line	:	4100 LAKE OTIS PKWY STE 220
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5230
Country	:	US
Telephone Number	:	907-563-3145
Fax Number	:	833-464-5196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	01/02/2025

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Directions to “ DOUG A VERMILLION MD” Practice Location

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