1386608362 NPI number — DR. JONATHAN PAUL MUELLER M.D.

Table of content: DR. JONATHAN PAUL MUELLER M.D. (NPI 1386608362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386608362 NPI number — DR. JONATHAN PAUL MUELLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUELLER
Provider First Name:
JONATHAN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1386608362
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:
11240 KASKANAK CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE RIVER
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99577-7228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-622-8452
Provider Business Mailing Address Fax Number:
907-257-4717

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2925 DEBARR RD
Provider Second Line Business Practice Location Address:
SUITE 1600
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-2983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-257-7414
Provider Business Practice Location Address Fax Number:
907-257-4717
Provider Enumeration Date:
04/14/2006

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: 207R00000X , with the licence number:  MD050696L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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