Provider Demographics
NPI:1073509063
Name:GITOMER, JEREMY J (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:J
Last Name:GITOMER
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:PO BOX 196800
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99519-6800
Mailing Address - Country:US
Mailing Address - Phone:907-375-5200
Mailing Address - Fax:907-375-5201
Practice Address - Street 1:4015 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5211
Practice Address - Country:US
Practice Address - Phone:907-375-5200
Practice Address - Fax:907-375-5201
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5028207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1017876Medicaid
AK1017876Medicaid
AKH22641Medicare UPIN