1497713572 NPI number — BARBARA B WALIS DO

Table of content: BARBARA B WALIS DO (NPI 1497713572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497713572 NPI number — BARBARA B WALIS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALIS
Provider First Name:
BARBARA
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497713572
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:
PO BOX 130
Provider Second Line Business Mailing Address:
6000 KANAKANAK RD
Provider Business Mailing Address City Name:
DILLINGHAM
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-842-5201
Provider Business Mailing Address Fax Number:
907-842-9250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 KANAKANAK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DILLINGHAM
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-842-5201
Provider Business Practice Location Address Fax Number:
907-842-9250
Provider Enumeration Date:
05/01/2006

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: 207Q00000X , with the licence number:  4429 , 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: 8EZ604 . This is a "CLARKS POINT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ663 . This is a "KING SALMON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ693 . This is a "MANOKOTAK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ723 . This is a "PERRYVILLE CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ743 . This is a "PILOT POINT CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ505 . This is a "N ALEKNAGIK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ534 . This is a "S ALEKNAGIK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ733 . This is a "PORT HEIDEN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ524 . This is a "KANAKANAK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ544 . This is a "CHIG LAGOON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ653 . This is a "IVANOFF BAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ643 . This is a "IGIUGIG CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ703 . This is a "NAKNEK CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ673 . This is a "KOLIGANEK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ713 . This is a "NEW STUYAHOK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ683 . This is a "LEVELOCK CLINIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ515 . This is a "CHIG LAKE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8EZ623 . This is a "EKWOK CLINIC" identifier . This identifiers is of the category "OTHER".




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