MEDICARE: PLASTIC SURGEONS OF ALASKA, LLC

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	208200000X	Plastic Surgery Physician

General Provider Information

NPI Number	:	1871738674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLASTIC SURGEONS OF ALASKA, LLC

Provider Business Mailing Address
First Line	:	301 W NORTHERN LIGHTS BLVD STE 110
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-2652
Country	:	US
Telephone Number	:	907-563-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 W NORTHERN LIGHTS BLVD STE 110
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-2652
Country	:	US
Telephone Number	:	907-563-2002
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	JOHN COLE
Credential	:
Telephone Number	:	907-563-2002

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	05/27/2026

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