MEDICARE: ALFRED DAVID DERAMUS M.D.

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	207W00000X	Ophthalmology Physician	MD1850	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336145788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFRED DAVID DERAMUS M.D.

Provider Business Mailing Address
First Line	:	4001 GEIST RD
Second Line	:	STE 9
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-3569
Country	:	US
Telephone Number	:	907-479-0852
Fax Number	:	907-479-0859

Provider Business Practice Location Address
First Line	:	4001 GEIST RD
Second Line	:	STE 9
City	:	FAIRBANKS
State	:	AK
Zip	:	99709-3569
Country	:	US
Telephone Number	:	907-479-0852
Fax Number	:	907-479-0859

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	11/17/2009

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