Provider Demographics
NPI:1871738674
Name:PLASTIC SURGEONS OF ALASKA, LLC
Entity type:Organization
Organization Name:PLASTIC SURGEONS OF ALASKA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-563-2002
Mailing Address - Street 1:2741 DEBARR RD STE C215
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2978
Mailing Address - Country:US
Mailing Address - Phone:907-563-2002
Mailing Address - Fax:
Practice Address - Street 1:2741 DEBARR RD STE C215
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2978
Practice Address - Country:US
Practice Address - Phone:907-563-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty