1417042912 NPI number — DR. FRANK FIR MESDAG FRANK MESDAG

Table of content: DR. FRANK FIR MESDAG FRANK MESDAG (NPI 1417042912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417042912 NPI number — DR. FRANK FIR MESDAG FRANK MESDAG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESDAG
Provider First Name:
FRANK
Provider Middle Name:
FIR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
FRANK MESDAG
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MESDAG
Provider Other First Name:
FEIKO
Provider Other Middle Name:
FIR
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FRANK MESDAG
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1417042912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 32497
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNEAU
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99803-2497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-790-3586
Provider Business Mailing Address Fax Number:
907-790-3335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8800 GLACIER HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 218
Provider Business Practice Location Address City Name:
JUNEAU
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99801-8080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-789-0405
Provider Business Practice Location Address Fax Number:
907-789-2925
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  AA1612 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PD1612 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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