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NPI Code Detail

MEDICARE: BEAUFORD HORMAN

MEDICARE: BEAUFORD HORMAN
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
1175T00000XPeer Specialist

General Provider Information

NPI Number : 1669075263
Entity Type Code : Individual
Provider Name (Legal Business Name) : BEAUFORD HORMAN
Provider Business Mailing Address
First Line : 591 S KNIK GOOSE BAY RD
Second Line :
City : WASILLA
State : AK
Zip : 99654-8062
Country : US
Telephone Number : 907-313-1333
Fax Number :
Provider Business Practice Location Address
First Line : 1419 S KITTIWAKE ST
Second Line :
City : WASILLA
State : AK
Zip : 99623-9302
Country : US
Telephone Number : 907-313-1333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2020
Last Update Date : 11/17/2020

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Directions to “ BEAUFORD HORMAN ” Practice Location

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