MEDICARE: BARBARA B WALIS DO

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	207Q00000X	Family Medicine Physician	4429	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	8EZ604	OTHER	CLARKS POINT
2	8EZ663	OTHER	KING SALMON
3	8EZ693	OTHER	MANOKOTAK
4	8EZ723	OTHER	PERRYVILLE CLINIC
5	8EZ743	OTHER	PILOT POINT CLINIC
6	8EZ505	OTHER	N ALEKNAGIK
7	8EZ534	OTHER	S ALEKNAGIK
8	8EZ733	OTHER	PORT HEIDEN
9	8EZ524	OTHER	KANAKANAK
10	8EZ544	OTHER	CHIG LAGOON
11	8EZ653	OTHER	IVANOFF BAY
12	8EZ643	OTHER	IGIUGIG CLINIC
13	8EZ703	OTHER	NAKNEK CLINIC
14	8EZ673	OTHER	KOLIGANEK
15	8EZ713	OTHER	NEW STUYAHOK
16	8EZ683	OTHER	LEVELOCK CLINIC
17	8EZ515	OTHER	CHIG LAKE
18	8EZ623	OTHER	EKWOK CLINIC

General Provider Information

NPI Number	:	1497713572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA B WALIS DO

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:	6000 KANAKANAK RD
City	:	DILLINGHAM
State	:	AK
Zip	:	99576
Country	:	US
Telephone Number	:	907-842-5201
Fax Number	:	907-842-9250

Provider Business Practice Location Address
First Line	:	6000 KANAKANAK RD
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576
Country	:	US
Telephone Number	:	907-842-5201
Fax Number	:	907-842-9250

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

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	07/08/2007

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