MEDICARE: DR. TRICIA BUTTON ELLIOTT MCDONAGH 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	207R00000X	Internal Medicine Physician	5822	AK

General Provider Information

NPI Number	:	1477658540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRICIA BUTTON ELLIOTT MCDONAGH M.D.

Provider Business Mailing Address
First Line	:	247 N FIREWEED ST
Second Line	:	SUITE A
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7540
Country	:	US
Telephone Number	:	907-262-8597
Fax Number	:	907-262-6516

Provider Business Practice Location Address
First Line	:	247 N FIREWEED ST
Second Line	:	SUITE A
City	:	SOLDOTNA
State	:	AK
Zip	:	99669-7540
Country	:	US
Telephone Number	:	907-262-8597
Fax Number	:	907-262-6516

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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