Provider Demographics
NPI:1043727878
Name:FAIRBANKS UROLOGY
Entity type:Organization
Organization Name:FAIRBANKS UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIMEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-686-6809
Mailing Address - Street 1:607 OLD STEESE HWY STE B306
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3163
Mailing Address - Country:US
Mailing Address - Phone:617-686-6809
Mailing Address - Fax:
Practice Address - Street 1:1211 CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4680
Practice Address - Country:US
Practice Address - Phone:617-686-6809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty