Provider Demographics
NPI:1003893611
Name:AINSWORTH, JERRY Z (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:Z
Last Name:AINSWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 TONGASS DR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835-9416
Mailing Address - Country:US
Mailing Address - Phone:907-966-2411
Mailing Address - Fax:907-966-8606
Practice Address - Street 1:222 TONGASS DR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835-9416
Practice Address - Country:US
Practice Address - Phone:907-966-2411
Practice Address - Fax:907-966-8606
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3944207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3944Medicare ID - Type Unspecified
AK8EZ96AMedicare ID - Type Unspecified
AKC96818Medicare UPIN
AK8EZ12BMedicare ID - Type Unspecified
AK8EZ78AMedicare ID - Type Unspecified
AK8EZ03BMedicare ID - Type Unspecified
AK8EZ82AMedicare ID - Type Unspecified