MEDICARE: DOUGLAS PREVOST 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	207X00000X	Orthopaedic Surgery Physician	MEDS5369	AK

General Provider Information

NPI Number	:	1952376022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS PREVOST M.D.

Provider Business Mailing Address
First Line	:	4100 LAKE OTIS PKWY STE 108
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5230
Country	:	US
Telephone Number	:	907-563-3145
Fax Number	:	833-464-5196

Provider Business Practice Location Address
First Line	:	4100 LAKE OTIS PKWY STE 108
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5230
Country	:	US
Telephone Number	:	907-563-3145
Fax Number	:	833-464-5196

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	11/27/2023

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