1871709873 NPI number — JOHN D. FROST, M.D., APC

Table of content: (NPI 1871709873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871709873 NPI number — JOHN D. FROST, M.D., APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN D. FROST, M.D., APC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1871709873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4100 LAKE OTIS PKWY
Provider Second Line Business Mailing Address:
#302
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-5222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-563-7072
Provider Business Mailing Address Fax Number:
907-562-5742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 LAKE OTIS PKWY
Provider Second Line Business Practice Location Address:
#302
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-5222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-563-7072
Provider Business Practice Location Address Fax Number:
907-562-5742
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FROST
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
907-563-7072

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: MD1251 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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