1740289222 NPI number — MARK T CAYLOR MD

Table of content: MARK T CAYLOR MD (NPI 1740289222)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740289222 NPI number — MARK T CAYLOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAYLOR
Provider First Name:
MARK
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1740289222
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4015 LAKE OTIS PKWY STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-5235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-771-3500
Provider Business Mailing Address Fax Number:
907-771-3550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 LAKE OTIS
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-563-2663
Provider Business Practice Location Address Fax Number:
907-333-2948
Provider Enumeration Date:
07/18/2005

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: 207X00000X , with the licence number:  6132 , 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: 5344480 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 59167304 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 207X00000X . This is a "TAXONOMY CODE" identifier , issued by the state of ( AK ) . This identifiers is of the category "OTHER".
  • Identifier: 1011968 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 13007 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 009918765 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 264484300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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