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NPI Code Detail

MEDICARE: ROY FUKUOKA

MEDICARE: ROY FUKUOKA
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
1367500000XCertified Registered Nurse Anesthetist281AK

General Provider Information

NPI Number : 1629067590
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY FUKUOKA
Provider Business Mailing Address
First Line : 8737 INYO CIR
Second Line :
City : EAGLE RIVER
State : AK
Zip : 99577-9402
Country : US
Telephone Number : 907-227-0162
Fax Number :
Provider Business Practice Location Address
First Line : 2500 S WOODWORTH LOOP
Second Line :
City : PALMER
State : AK
Zip : 99645-8984
Country : US
Telephone Number : 907-227-0162
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 10/15/2010

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Directions to “ ROY FUKUOKA ” Practice Location

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