1881668556 NPI number — DR. JAMES MICHAEL FITTERLING PH.D.

Table of content: DR. JAMES MICHAEL FITTERLING PH.D. (NPI 1881668556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881668556 NPI number — DR. JAMES MICHAEL FITTERLING PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITTERLING
Provider First Name:
JAMES
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.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:
1881668556
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:
ALASKA VA HEALTHCARE SYSTEM AND REGIONAL OFFICE
Provider Second Line Business Mailing Address:
3001 C STREET
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99503-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-273-4078
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 C ST
Provider Second Line Business Practice Location Address:
ALASKA VA HEALTHCARE SYSTEM AND REGIONAL OFFICE
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99503-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-273-4078
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2006

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: 103TC0700X , with the licence number:  28-384 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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